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 |
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Provider Enumeration Date | 12/05/2017 |
Last Update Date | 12/05/2017 |
Medicare PECOS PAC ID | 5193086205 |
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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 |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1497977375 PECOS PAC ID: 2769743855 Enrollment ID: I20180306002853 |
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