Provider Demographics
NPI:1982132718
Name:SUPPORT THROUGHOUT THE JOURNEY, LLC
Entity Type:Organization
Organization Name:SUPPORT THROUGHOUT THE JOURNEY, LLC
Other - Org Name:THERESA A. MONTELLI-CAVOTO, LCSW
Other - Org Type:Other Name
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MONTELLI-CAVOTO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-414-5393
Mailing Address - Street 1:775 CHICKADEE LN
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-2479
Mailing Address - Country:US
Mailing Address - Phone:203-414-5393
Mailing Address - Fax:
Practice Address - Street 1:238 MONROE TPKE UNIT B
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-6200
Practice Address - Country:US
Practice Address - Phone:203-414-5393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-24
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008071411Medicaid