Provider Demographics
NPI:1902159528
Name:EXHALE BREATHE AND LET GO
Entity type:Organization
Organization Name:EXHALE BREATHE AND LET GO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:DEYOUNGE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:203-589-1115
Mailing Address - Street 1:16 BEAVER HILL LN
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-1639
Mailing Address - Country:US
Mailing Address - Phone:203-589-1115
Mailing Address - Fax:
Practice Address - Street 1:214 AMITY RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2241
Practice Address - Country:US
Practice Address - Phone:203-589-1115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty