# STONY CREEK WELLNESS GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598209116
- **Authorized official:** TRICIA L MIGNOSA APRN (OWNER)
- **Authorized official phone:** (203) 693-4566

## Contact information

- **Practice address:** 2415 BOSTON POST RD, UNIT 12, GUILFORD, CT 06437-4348
- **Practice address phone:** (203) 693-4566
- **Practice address fax:** (203) 457-5970
- **Mailing address:** 2415 BOSTON POST RD, UNIT 12, GUILFORD, CT 06437-4348
- **Mailing address phone:** (203) 693-4566
- **Mailing address fax:** (203) 457-5970

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YP2500X | Professional Counselor | 1922 | CT | — |
| 1041C0700X | Clinical Social Worker | 9481 | CT | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 5763 | CT | Yes |

## Other

- **Enumeration date:** 12/16/2016
- **Last updated:** 12/16/2016