Provider Demographics
NPI:1477897304
Name:THERAPEUTIC PATHWAYS
Entity Type:Organization
Organization Name:THERAPEUTIC PATHWAYS
Other - Org Name:THERAPEUTIC PATHWAYS
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKNIAK
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:203-723-4332
Mailing Address - Street 1:175 CHURCH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-4180
Mailing Address - Country:US
Mailing Address - Phone:203-723-8546
Mailing Address - Fax:203-723-9250
Practice Address - Street 1:175 CHURCH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4180
Practice Address - Country:US
Practice Address - Phone:203-723-8546
Practice Address - Fax:203-723-9250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2014-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
CT0062611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty