Provider Demographics
NPI:1972211563
Name:EMOTIONAL REVIVAL LLC
Entity Type:Organization
Organization Name:EMOTIONAL REVIVAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSSANA
Authorized Official - Middle Name:SILVA
Authorized Official - Last Name:SPRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-593-6310
Mailing Address - Street 1:130 HOFFMAN RD
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-2421
Mailing Address - Country:US
Mailing Address - Phone:860-593-6310
Mailing Address - Fax:
Practice Address - Street 1:130 HOFFMAN RD
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06029-2421
Practice Address - Country:US
Practice Address - Phone:860-593-6310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty