Organization
BALANCED ZEN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA LAFARO LCSW (LICENSED CLINICAL SOCIAL WORKER)
(203) 505-0023
Entity
Organization
Contact information
Practice address
60 KATONA DR STE 22, FAIRFIELD, CT 06824-3544
(203) 505-0023
Mailing address
3200 MADISON AVE UNIT 33, BRIDGEPORT, CT 06606-2046
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
8854
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
558719070
—
CT
Enumeration date
09/07/2018
Last updated
09/07/2018
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