Provider Demographics
NPI:1467819375
Name:HEALING HEARTS LLC
Entity Type:Organization
Organization Name:HEALING HEARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHALITA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-623-9786
Mailing Address - Street 1:PO BOX 9134
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06532-0134
Mailing Address - Country:US
Mailing Address - Phone:203-623-9786
Mailing Address - Fax:203-745-4215
Practice Address - Street 1:75 BROOK HILL RD
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-2001
Practice Address - Country:US
Practice Address - Phone:203-623-9786
Practice Address - Fax:203-745-4215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0088101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty