| Embrace Your Path, Llc | |
|
4270 Main St Bridgeport CT 06606-2306 | |
| (203) 301-8852 | |
| (203) 301-8852 |
| Full Name | Embrace Your Path, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4270 Main St, Bridgeport, Connecticut |
| Authorized Official Name and Position | Deborah Shillingford (OWNER/MANAGER) |
| Authorized Official Contact | 2035209910 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Embrace Your Path, Llc 39 Cogswell St Bridgeport CT 06610-1913 Ph: (203) 520-9910 | Embrace Your Path, Llc 4270 Main St Bridgeport CT 06606-2306 Ph: (203) 301-8852 |
| NPI Number | 1033624614 |
|---|---|
| Provider Enumeration Date | 12/05/2017 |
| Last Update Date | 12/05/2017 |
| Medicare PECOS PAC ID | 5193086205 |
|---|---|
| Medicare Enrollment ID | O20180307000718 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033624614 | NPI | - | NPPES |
| 1497977375 | Other | CT | BEHAVIORAL HEALTH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 007937 (Connecticut) | Primary |
| Provider Name | Deborah Shillingford |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497977375 PECOS PAC ID: 2769743855 Enrollment ID: I20180306002853 |
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