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Organization
WEAVE YOUR LIFE LLC
Active
Organization
WEAVE YOUR LIFE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUDREY L BENNETT (MANAGER)
(860) 819-8570
Entity
Organization
Contact information
Practice address
963 QUEEN ST, SUITE C, SOUTHINGTON, CT 06489-1282
(860) 819-8570
Mailing address
963 QUEEN ST, SUITE C, SOUTHINGTON, CT 06489-1282
(860) 819-8570
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
006194
CT
251S00000X
Community/Behavioral Health Agency
000729
CT
251S00000X
Community/Behavioral Health Agency
006194
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008040743
—
CT
Enumeration date
03/04/2010
Last updated
08/13/2012
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