Provider Demographics
NPI:1942968151
Name:REDEEM WELLNESS CENTER II, LLC
Entity Type:Organization
Organization Name:REDEEM WELLNESS CENTER II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-208-3940
Mailing Address - Street 1:19 LUDLOW RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-3040
Mailing Address - Country:US
Mailing Address - Phone:203-208-3940
Mailing Address - Fax:203-693-4900
Practice Address - Street 1:19 LUDLOW RD
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3040
Practice Address - Country:US
Practice Address - Phone:203-208-3940
Practice Address - Fax:203-693-4900
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REDEEM WELLNESS CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-05
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008089942Medicaid