Organization
A PROSPERING VISION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ELIJAH CALDWELL LCSW (EXECUTIVE PROGRAM DIRECTOR)
(203) 558-9865
Entity
Organization
Contact information
Practice address
60 N MAIN ST, 3RD FLR, WATERBURY, CT 06702-1443
(203) 558-9865
Mailing address
60 N MAIN ST, 3RD FLR, WATERBURY, CT 06702-1443
(203) 558-9865
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
2084D0003X
Diagnostic Neuroimaging (Psychiatry & Neurology) Physician
040650
CT
251S00000X
Community/Behavioral Health Agency
54084595001
CT
363LF0000X
Family Nurse Practitioner
5149
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008042640
—
CT
Enumeration date
02/29/2012
Last updated
11/22/2016
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