Organization
MYSTIC BRIDGE TO WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAUREN ST. AMOUR (CLINICIAN)
(617) 416-0597
Entity
Organization
Contact information
Practice address
47 WATER ST STE 202, MYSTIC, CT 06355-2573
(617) 416-0597
Mailing address
11 JOYCE ST, MYSTIC, CT 06355-2947
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
10/19/2021
Last updated
10/22/2021
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