Provider Demographics
NPI:1053709535
Name:SPIRALPATH HEALING CENTER, LLC.
Entity type:Organization
Organization Name:SPIRALPATH HEALING CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:APRN,CNS
Authorized Official - Phone:203-247-9636
Mailing Address - Street 1:1 BONNYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-2703
Mailing Address - Country:US
Mailing Address - Phone:203-247-9636
Mailing Address - Fax:203-956-0570
Practice Address - Street 1:258 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-2748
Practice Address - Country:US
Practice Address - Phone:203-247-9636
Practice Address - Fax:203-956-0570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380079363LP0200X
CT002713364SH1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SH1100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHolisticGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty