Organization
GLOW UP THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA JELDEN LCSW (CO-OWNER)
(860) 772-4424
Entity
Organization
Contact information
Practice address
11 MAIN ST, MYSTIC, CT 06355-3654
(860) 772-4424
Mailing address
11 MAIN ST, MYSTIC, CT 06355-3654
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008069342
—
CT
Enumeration date
06/02/2019
Last updated
06/11/2019
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