Provider Demographics
NPI:1629196795
Name:BALANCED FOR SUCCESS, LLC
Entity Type:Organization
Organization Name:BALANCED FOR SUCCESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MARRIAGE FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SOTTERY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-605-1399
Mailing Address - Street 1:1314 ASPEN GLEN DR
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-5320
Mailing Address - Country:US
Mailing Address - Phone:203-605-1399
Mailing Address - Fax:203-288-6096
Practice Address - Street 1:53 RIVER ST
Practice Address - Street 2:SUITE 11
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3346
Practice Address - Country:US
Practice Address - Phone:203-605-1399
Practice Address - Fax:203-288-6096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001156106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty