Provider Demographics
NPI:1710427851
Name:BREAK FREE CENTER FOR WELLNESS
Entity Type:Organization
Organization Name:BREAK FREE CENTER FOR WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARRON
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:RILEY-SEYMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-881-3076
Mailing Address - Street 1:130 VERNON AVE
Mailing Address - Street 2:APARTMENT 2H
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-3656
Mailing Address - Country:US
Mailing Address - Phone:860-881-3076
Mailing Address - Fax:
Practice Address - Street 1:642 HILLIARD ST
Practice Address - Street 2:SUITE 1223
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-2700
Practice Address - Country:US
Practice Address - Phone:860-327-5790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002815101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty