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Organization
STONY CREEK WELLNESS GROUP, LLC
Active
Organization
STONY CREEK WELLNESS GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRICIA L MIGNOSA APRN (OWNER)
(203) 693-4566
Entity
Organization
Contact information
Practice address
2415 BOSTON POST RD, UNIT 12, GUILFORD, CT 06437-4348
(203) 693-4566
(203) 457-5970
Mailing address
2415 BOSTON POST RD, UNIT 12, GUILFORD, CT 06437-4348
(203) 693-4566
(203) 457-5970
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
1922
CT
1041C0700X
Clinical Social Worker
9481
CT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
5763
CT
Other
Enumeration date
12/16/2016
Last updated
12/16/2016
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