| Glow Up Therapy | |
|
11 Main St Mystic CT 06355-3654 | |
| (860) 772-4424 | |
| Not Available |
| Full Name | Glow Up Therapy |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 11 Main St, Mystic, Connecticut |
| Authorized Official Name and Position | Amanda Jelden (CO-OWNER) |
| Authorized Official Contact | 8607724424 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Glow Up Therapy 11 Main St Mystic CT 06355-3654 Ph: () - | Glow Up Therapy 11 Main St Mystic CT 06355-3654 Ph: (860) 772-4424 |
| NPI Number | 1265090500 |
|---|---|
| Provider Enumeration Date | 06/02/2019 |
| Last Update Date | 06/11/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265090500 | NPI | - | NPPES |
| 008069342 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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