Organization
A FRESH START LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT MOORE (OWNER)
(203) 645-3071
Entity
Organization
Contact information
Practice address
30 HAZEL TER STE K, WOODBRIDGE, CT 06525-2240
(203) 572-1236
Mailing address
363 NORTON ST, NEW HAVEN, CT 06511-7115
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
10/18/2018
Last updated
10/18/2018
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