| Undivided Soul Llc | |
|
27 Siemon Company Dr Ste 315w Watertown CT 06795-2654 | |
| (203) 697-8983 | |
| (844) 436-9123 |
| Full Name | Undivided Soul Llc |
|---|---|
| Speciality | Counselor |
| Location | 27 Siemon Company Dr Ste 315w, Watertown, Connecticut |
| Authorized Official Name and Position | Kathryn Gelinas (LICENSED PROFESSIONAL COUNSELOR) |
| Authorized Official Contact | 2036978983 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Undivided Soul Llc 27 Siemon Company Dr Ste 315w Watertown CT 06795-2654 Ph: (203) 697-8983 | Undivided Soul Llc 27 Siemon Company Dr Ste 315w Watertown CT 06795-2654 Ph: (203) 697-8983 |
| NPI Number | 1558809178 |
|---|---|
| Provider Enumeration Date | 02/02/2017 |
| Last Update Date | 12/08/2025 |
| Certification Date | 12/08/2025 |
| Medicare PECOS PAC ID | 2860837697 |
|---|---|
| Medicare Enrollment ID | O20240301003125 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558809178 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 3103 (Connecticut) | Primary |
| Provider Name | Kathryn S Gelinas |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1356886014 PECOS PAC ID: 1850736687 Enrollment ID: I20240301003373 |
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