| Mystic Bridge To Wellness, Llc | |
|
47 Water St Ste 202 Mystic CT 06355-2573 | |
| (617) 416-0597 | |
| Not Available |
| Full Name | Mystic Bridge To Wellness, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 47 Water St Ste 202, Mystic, Connecticut |
| Authorized Official Name and Position | Lauren St. Amour (CLINICIAN) |
| Authorized Official Contact | 6174160597 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mystic Bridge To Wellness, Llc 11 Joyce St Mystic CT 06355-2947 Ph: () - | Mystic Bridge To Wellness, Llc 47 Water St Ste 202 Mystic CT 06355-2573 Ph: (617) 416-0597 |
| NPI Number | 1750044509 |
|---|---|
| Provider Enumeration Date | 10/19/2021 |
| Last Update Date | 10/22/2021 |
| Certification Date | 10/22/2021 |
| Medicare PECOS PAC ID | 6204200207 |
|---|---|
| Medicare Enrollment ID | O20230314002151 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750044509 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Emma E Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609240787 PECOS PAC ID: 5991069353 Enrollment ID: I20180510002287 |
| Provider Name | Daniel Stubbs Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306553482 PECOS PAC ID: 3173994902 Enrollment ID: I20230113001549 |
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