Illuminate Therapy LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

ILLUMINATE THERAPY LLC

Practice address

2 Klarides Village Dr # 272
Seymour, CT 06483-2737

Phone

(203) 490-7943

NPI assigned

Sep 13, 2021

Last updated

Sep 13, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Laura Lee Davis, LCSW

Title

Clinician

Phone

(203) 490-7943

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631491200000",
    "number": "1235808221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 KLARIDES VILLAGE DR # 272",
            "city": "SEYMOUR",
            "state": "CT",
            "postal_code": "064832737",
            "telephone_number": "203-490-7943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 KLARIDES VILLAGE DR # 272",
            "city": "SEYMOUR",
            "state": "CT",
            "postal_code": "064832737",
            "telephone_number": "203-490-7943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLUMINATE THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-13",
        "last_updated": "2021-09-13",
        "certification_date": "2021-08-30",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CLINICIAN",
        "authorized_official_telephone_number": "203-490-7943",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Seymour, CT
• Providers in Seymour, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.