Basic Information
| Provider Information | |||||||||
| NPI: | 1154969863 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CREATIVE HARMONY CLINICAL SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 309 TERRACE AVE APT 13 | ||||||||
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| City: | WEST HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065162618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038924215 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2911 DIXWELL AVE STE B-11 | ||||||||
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| City: | HAMDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065183152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035332276 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2019 | ||||||||
| LastUpdateDate: | 12/12/2019 | ||||||||
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| AuthorizedOfficialLastName: | BUNTA | ||||||||
| AuthorizedOfficialFirstName: | CAROLINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2038924215 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LMFT | ||||||||
| NPICertificationDate: | 12/12/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.