Provider Demographics
NPI:1912313008
Name:REFLECTIONS OF CHESTER, HEALTH & WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:REFLECTIONS OF CHESTER, HEALTH & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPLITTGERBER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-526-4212
Mailing Address - Street 1:19 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06412-1201
Mailing Address - Country:US
Mailing Address - Phone:860-526-4212
Mailing Address - Fax:860-526-2203
Practice Address - Street 1:19 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:CT
Practice Address - Zip Code:06412-1201
Practice Address - Country:US
Practice Address - Phone:860-526-4212
Practice Address - Fax:860-526-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001047101YM0800X, 103T00000X, 1041C0700X, 106H00000X, 261QM0801X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004199180Medicaid