| Headspace Llc | |
|
433 Silas Deane Hwy Wethersfield CT 06109-2123 | |
| (860) 837-0300 | |
| (860) 540-1069 |
| Full Name | Headspace Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 433 Silas Deane Hwy, Wethersfield, Connecticut |
| Authorized Official Name and Position | Samantha Burgos (OWNER) |
| Authorized Official Contact | 8608370300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Headspace Llc 433 Silas Deane Hwy Wethersfield CT 06109-2123 Ph: (860) 837-0300 | Headspace Llc 433 Silas Deane Hwy Wethersfield CT 06109-2123 Ph: (860) 837-0300 |
| NPI Number | 1083229355 |
|---|---|
| Provider Enumeration Date | 09/13/2020 |
| Last Update Date | 09/13/2020 |
| Certification Date | 09/13/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083229355 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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