| Tmw Wellness Pllc | |
|
504 Wolcott Rd Ste C Wolcott CT 06716-2462 | |
| (203) 504-9507 | |
| Not Available |
| Full Name | Tmw Wellness Pllc |
|---|---|
| Speciality | Counselor |
| Location | 504 Wolcott Rd Ste C, Wolcott, Connecticut |
| Authorized Official Name and Position | Shivanna Subramni-gonzalez (CMO) |
| Authorized Official Contact | 2037255339 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tmw Wellness Pllc 504 Wolcott Rd Ste C Wolcott CT 06716-2462 Ph: () - | Tmw Wellness Pllc 504 Wolcott Rd Ste C Wolcott CT 06716-2462 Ph: (203) 504-9507 |
| NPI Number | 1700580198 |
|---|---|
| Provider Enumeration Date | 03/29/2023 |
| Last Update Date | 03/29/2023 |
| Certification Date | 03/29/2023 |
| Medicare PECOS PAC ID | 7012366180 |
|---|---|
| Medicare Enrollment ID | O20231214001556 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700580198 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Shivanna Subramani-gonzalez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457758179 PECOS PAC ID: 4486979408 Enrollment ID: I20150216001827 |
| Provider Name | Jeffrey Gonzalez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1285405928 PECOS PAC ID: 3577916774 Enrollment ID: I20240124001228 |
| Provider Name | Melynda Ramona Cabrera |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811329246 PECOS PAC ID: 7719330729 Enrollment ID: I20240329000373 |
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