Provider Demographics
NPI:1710618293
Name:SYNERGY WELLNESS LLC
Entity Type:Organization
Organization Name:SYNERGY WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SNETRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-324-8747
Mailing Address - Street 1:75 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-5003
Mailing Address - Country:US
Mailing Address - Phone:860-324-8747
Mailing Address - Fax:
Practice Address - Street 1:741 BOSTON POST RD STE 308
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2714
Practice Address - Country:US
Practice Address - Phone:860-324-8747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2586832OtherSECRETARY OF THE STATE OF CONNECTICUT