Provider Demographics
NPI:1700341021
Name:HEART OF WISDOM COUNSELING AND PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:HEART OF WISDOM COUNSELING AND PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SMITH
Authorized Official - Middle Name:
Authorized Official - Last Name:KIDKARNDEE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:917-445-6423
Mailing Address - Street 1:181 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:CT
Mailing Address - Zip Code:06248-1125
Mailing Address - Country:US
Mailing Address - Phone:917-445-6423
Mailing Address - Fax:
Practice Address - Street 1:41C NEW LONDON TPKE
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4206
Practice Address - Country:US
Practice Address - Phone:860-288-7041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-01
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty