| Wild Empowerment Llc | |
|
4 Research Dr Ste 402 Shelton CT 06484-6242 | |
| (203) 951-1393 | |
| Not Available |
| Full Name | Wild Empowerment Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 4 Research Dr Ste 402, Shelton, Connecticut |
| Authorized Official Name and Position | Gina Amante (OWNER / CLINICIAN) |
| Authorized Official Contact | 2039511393 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wild Empowerment Llc 4 Research Dr Ste 402 Shelton CT 06484-6242 Ph: () - | Wild Empowerment Llc 4 Research Dr Ste 402 Shelton CT 06484-6242 Ph: (203) 951-1393 |
| NPI Number | 1831885359 |
|---|---|
| Provider Enumeration Date | 04/17/2023 |
| Last Update Date | 04/18/2023 |
| Certification Date | 04/18/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831885359 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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