| Peace Connection Pllc | |
|
12 Roosevelt Ave Ste 2 Mystic CT 06355-2832 | |
| (860) 485-7992 | |
| Not Available |
| Full Name | Peace Connection Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 12 Roosevelt Ave Ste 2, Mystic, Connecticut |
| Authorized Official Name and Position | Jeannine Cleaver (OWNER) |
| Authorized Official Contact | 8602459840 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peace Connection Pllc 11 Boston Post Rd Fl 2 Waterford CT 06385-2401 Ph: () - | Peace Connection Pllc 12 Roosevelt Ave Ste 2 Mystic CT 06355-2832 Ph: (860) 485-7992 |
| NPI Number | 1306564976 |
|---|---|
| Provider Enumeration Date | 08/18/2022 |
| Last Update Date | 01/22/2025 |
| Certification Date | 01/22/2025 |
| Medicare PECOS PAC ID | 7214458439 |
|---|---|
| Medicare Enrollment ID | O20250304003361 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306564976 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jeannine Cleaver |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336591924 PECOS PAC ID: 7517396781 Enrollment ID: I20221210000472 |
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