Provider Demographics
NPI:1053160697
Name:LIFT TEEN AND PARENT WELLNESS CENTERS
Entity type:Organization
Organization Name:LIFT TEEN AND PARENT WELLNESS CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT, CEDS
Authorized Official - Phone:203-526-3215
Mailing Address - Street 1:116 MILE COMMON RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06612-1506
Mailing Address - Country:US
Mailing Address - Phone:203-526-3215
Mailing Address - Fax:
Practice Address - Street 1:8 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3511
Practice Address - Country:US
Practice Address - Phone:203-526-3215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)