Provider Demographics
NPI:1497415129
Name:HEAL ON PURPOSE LLC
Entity Type:Organization
Organization Name:HEAL ON PURPOSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:FORRESTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-983-1303
Mailing Address - Street 1:20 ASTOR PL
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-4124
Mailing Address - Country:US
Mailing Address - Phone:860-983-1303
Mailing Address - Fax:
Practice Address - Street 1:20 ASTOR PL
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-4124
Practice Address - Country:US
Practice Address - Phone:860-983-1303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health