Basic Information
| Provider Information | |||||||||
| NPI: | 1912341652 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE ALLUVIUM THERAPY GROUP INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 462 | ||||||||
| Address2: | |||||||||
| City: | LAKEVILLE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060390462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7812801699 | ||||||||
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| Practice Location | |||||||||
| Address1: | 22 UPPER MAIN ST | ||||||||
| Address2: | SUITE F | ||||||||
| City: | SHARON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060692083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602485955 | ||||||||
| FaxNumber: | 8603645445 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2013 | ||||||||
| LastUpdateDate: | 07/11/2013 | ||||||||
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| AuthorizedOfficialLastName: | BERG | ||||||||
| AuthorizedOfficialFirstName: | RACHEL | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8602485955 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.