Provider Demographics
NPI:1831887793
Name:LIFT PATHWAYS TO RENEWAL
Entity type:Organization
Organization Name:LIFT PATHWAYS TO RENEWAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:DOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-526-3215
Mailing Address - Street 1:116 MILE COMMON RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06612-1506
Mailing Address - Country:US
Mailing Address - Phone:203-526-3215
Mailing Address - Fax:
Practice Address - Street 1:8 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3511
Practice Address - Country:US
Practice Address - Phone:203-526-3215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
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
No251S00000XAgenciesCommunity/Behavioral Health