Provider Demographics
NPI:1952940140
Name:SHADES GREENER, LLC
Entity Type:Organization
Organization Name:SHADES GREENER, LLC
Other - Org Name:ALLISON BOMBARD LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:BOMBARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-339-2593
Mailing Address - Street 1:18 LYDALE PL
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-6125
Mailing Address - Country:US
Mailing Address - Phone:203-339-2593
Mailing Address - Fax:
Practice Address - Street 1:18 LYDALE PL
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-6125
Practice Address - Country:US
Practice Address - Phone:203-514-4189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-05
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health