Provider Demographics
NPI:1700580198
Name:TMW WELLNESS PLLC
Entity Type:Organization
Organization Name:TMW WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:SHIVANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUBRAMNI-GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:203-725-5339
Mailing Address - Street 1:504 WOLCOTT RD STE C
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-2462
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:504 WOLCOTT RD STE C
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-2462
Practice Address - Country:US
Practice Address - Phone:203-504-9507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MODERN WOMAN HEALTH & WELLNESS CENTER PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty