| Balanced Zen Llc | |
|
60 Katona Dr Ste 22 Fairfield CT 06824-3544 | |
| (203) 505-0023 | |
| Not Available |
| Full Name | Balanced Zen Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 60 Katona Dr Ste 22, Fairfield, Connecticut |
| Authorized Official Name and Position | Andrea Lafaro (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 2035050023 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Balanced Zen Llc 3200 Madison Ave Unit 33 Bridgeport CT 06606-2046 Ph: () - | Balanced Zen Llc 60 Katona Dr Ste 22 Fairfield CT 06824-3544 Ph: (203) 505-0023 |
| NPI Number | 1740763507 |
|---|---|
| Provider Enumeration Date | 09/07/2018 |
| Last Update Date | 09/07/2018 |
| Medicare PECOS PAC ID | 7810231271 |
|---|---|
| Medicare Enrollment ID | O20181212000820 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740763507 | NPI | - | NPPES |
| 558719070 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 8854 (Connecticut) | Primary |
| Provider Name | Andrea Lafaro |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558719070 PECOS PAC ID: 8820374523 Enrollment ID: I20170412001015 |
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