| Phoenix Rising Wellness Llc | |
|
153 S Main St Newtown CT 06470-2791 | |
| (203) 556-2030 | |
| Not Available |
| Full Name | Phoenix Rising Wellness Llc |
|---|---|
| Speciality | Social Worker |
| Location | 153 S Main St, Newtown, Connecticut |
| Authorized Official Name and Position | Alyssa Kondor (OWNER) |
| Authorized Official Contact | 2035562030 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Rising Wellness Llc 29 Lucius Ct Milford CT 06461-3093 Ph: (203) 556-2030 | Phoenix Rising Wellness Llc 153 S Main St Newtown CT 06470-2791 Ph: (203) 556-2030 |
| NPI Number | 1114772456 |
|---|---|
| Provider Enumeration Date | 04/19/2024 |
| Last Update Date | 04/19/2024 |
| Certification Date | 04/19/2024 |
| Medicare PECOS PAC ID | 8729523139 |
|---|---|
| Medicare Enrollment ID | O20240710001611 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114772456 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Alyssa Ashly Kondor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164991451 PECOS PAC ID: 1557723640 Enrollment ID: I20230822002407 |
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