| Elation Wellness | |
|
1057 Broad St Bridgeport CT 06604-4219 | |
| (860) 661-2925 | |
| Not Available |
| Full Name | Elation Wellness |
|---|---|
| Speciality | Social Worker |
| Location | 1057 Broad St, Bridgeport, Connecticut |
| Authorized Official Name and Position | Maria Camila Smith (CLINICIAN) |
| Authorized Official Contact | 2033087835 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elation Wellness 248 Toby Hill Rd Westbrook CT 06498-3521 Ph: () - | Elation Wellness 1057 Broad St Bridgeport CT 06604-4219 Ph: (860) 661-2925 |
| NPI Number | 1487109252 |
|---|---|
| Provider Enumeration Date | 08/22/2016 |
| Last Update Date | 04/02/2018 |
| Medicare PECOS PAC ID | 5092094615 |
|---|---|
| Medicare Enrollment ID | O20161122000524 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487109252 | NPI | - | NPPES |
| 004235918 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Maria Camila Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326437336 PECOS PAC ID: 5991010290 Enrollment ID: I20150817000138 |
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