Provider Demographics
NPI:1578920187
Name:GREATER HARTFORD WELLNESS
Entity Type:Organization
Organization Name:GREATER HARTFORD WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WAWRZYNIAK WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:860-878-2028
Mailing Address - Street 1:10 N MAIN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1968
Mailing Address - Country:US
Mailing Address - Phone:860-878-2028
Mailing Address - Fax:860-236-2016
Practice Address - Street 1:10 N MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1968
Practice Address - Country:US
Practice Address - Phone:860-878-2028
Practice Address - Fax:860-236-2016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3003251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008045960Medicaid