Provider Demographics
NPI:1932473527
Name:A PROSPERING VISION, LLC
Entity Type:Organization
Organization Name:A PROSPERING VISION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ELIJAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-558-9865
Mailing Address - Street 1:60 N MAIN ST
Mailing Address - Street 2:3RD FLR
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-1443
Mailing Address - Country:US
Mailing Address - Phone:203-558-9865
Mailing Address - Fax:
Practice Address - Street 1:60 N MAIN ST
Practice Address - Street 2:3RD FLR
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-1443
Practice Address - Country:US
Practice Address - Phone:203-558-9865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CT0406502084D0003X
CT54084595001251S00000X
CT5149363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic NeuroimagingGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008042640Medicaid