| Mystic Therapy, Llc. | |
|
49 Whitehall Ave Mystic CT 06355-1966 | |
| (860) 961-5702 | |
| (866) 740-0281 |
| Full Name | Mystic Therapy, Llc. |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 49 Whitehall Ave, Mystic, Connecticut |
| Authorized Official Name and Position | Danielle Drugan (OWNER) |
| Authorized Official Contact | 8609615702 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mystic Therapy, Llc. 21 New London Rd Mystic CT 06355-2452 Ph: (860) 961-5702 | Mystic Therapy, Llc. 49 Whitehall Ave Mystic CT 06355-1966 Ph: (860) 961-5702 |
| NPI Number | 1043517733 |
|---|---|
| Provider Enumeration Date | 02/16/2011 |
| Last Update Date | 10/23/2019 |
| Medicare PECOS PAC ID | 9335496447 |
|---|---|
| Medicare Enrollment ID | O20180720000966 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043517733 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | 001404 (Connecticut) | Primary |
| Provider Name | Heather Nicole Bodie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477195899 PECOS PAC ID: 8224460498 Enrollment ID: I20191111000720 |
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