Provider Demographics
NPI:1588028641
Name:THERAPY AND WELLNESS FOR WOMEN LLC
Entity Type:Organization
Organization Name:THERAPY AND WELLNESS FOR WOMEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:WOLD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:860-595-2890
Mailing Address - Street 1:769 FARMINGTON AVE
Mailing Address - Street 2:BOX 11
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2364
Mailing Address - Country:US
Mailing Address - Phone:860-595-2890
Mailing Address - Fax:
Practice Address - Street 1:769 FARMINGTON AVE
Practice Address - Street 2:BOX 11
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2364
Practice Address - Country:US
Practice Address - Phone:860-595-2890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001749261QM0801X
CT001744261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008060366Medicaid
CT008061998Medicaid