| Kairos Therapy Center Llc | |
|
11 Main St Ste 3g Mystic CT 06355-3654 | |
| (860) 303-3777 | |
| Not Available |
| Full Name | Kairos Therapy Center Llc |
|---|---|
| Speciality | Social Worker |
| Location | 11 Main St Ste 3g, Mystic, Connecticut |
| Authorized Official Name and Position | Jessica Sormrude (OWNER) |
| Authorized Official Contact | 8603033777 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kairos Therapy Center Llc 11 Main St Ste 3g Mystic CT 06355-3654 Ph: () - | Kairos Therapy Center Llc 11 Main St Ste 3g Mystic CT 06355-3654 Ph: (860) 303-3777 |
| NPI Number | 1407481112 |
|---|---|
| Provider Enumeration Date | 03/03/2020 |
| Last Update Date | 06/08/2020 |
| Certification Date | 06/08/2020 |
| Medicare PECOS PAC ID | 6002237567 |
|---|---|
| Medicare Enrollment ID | O20200609001594 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407481112 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jessica W. Sormrude |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457865099 PECOS PAC ID: 3476981325 Enrollment ID: I20200309000257 |
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