Provider Demographics
NPI:1740932052
Name:DAYSPRING THERAPEUTIC GROUP LLC
Entity type:Organization
Organization Name:DAYSPRING THERAPEUTIC GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KHALILAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-936-9510
Mailing Address - Street 1:PO BOX 6685
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-0685
Mailing Address - Country:US
Mailing Address - Phone:203-936-9510
Mailing Address - Fax:
Practice Address - Street 1:30 HAZEL TER STE 20
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2240
Practice Address - Country:US
Practice Address - Phone:203-936-9510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty