Provider Demographics
NPI:1023724739
Name:THE PARENT & CHILD WELLNESS CENTER LLC
Entity type:Organization
Organization Name:THE PARENT & CHILD WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KATE
Authorized Official - Last Name:ROBB
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-556-7125
Mailing Address - Street 1:320 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06612-1422
Mailing Address - Country:US
Mailing Address - Phone:203-556-7125
Mailing Address - Fax:
Practice Address - Street 1:320 N PARK AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:CT
Practice Address - Zip Code:06612-1422
Practice Address - Country:US
Practice Address - Phone:203-556-7125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health