Provider Demographics
NPI:1689229676
Name:THRIVE WELLNESS & THERAPEUTICS LLC
Entity Type:Organization
Organization Name:THRIVE WELLNESS & THERAPEUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIBIASI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-806-5757
Mailing Address - Street 1:1200 HIGH RIDGE RD STE 208
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1202
Mailing Address - Country:US
Mailing Address - Phone:203-539-0751
Mailing Address - Fax:
Practice Address - Street 1:1200 HIGH RIDGE RD STE 208
Practice Address - Street 2:C/O SONDERCENTERES
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1202
Practice Address - Country:US
Practice Address - Phone:203-539-0751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-06
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty