NPIMap

Organization Active NPI

Revive Wellness LLC

  • Clinical Social Worker
  • Naugatuck, CT
National Provider Identifier
1235884073
Registry record updated Feb 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
REVIVE WELLNESS LLC
Practice address
81 Wisteria Dr
Naugatuck, CT 06770-5235
Phone
(203) 501-4624
NPI assigned
Feb 21, 2022
Last updated
Feb 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2022

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

Authorized official

Name
Danielle Moraes, LCSWNPI 1922420330
Title
Director
Phone
(203) 501-4624

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X
Clinical Social Worker 1041C0700X Primary
Marriage & Family Therapist 106H00000X
Family Nurse Practitioner 363LF0000X

Addresses

Primary practice location

81 Wisteria Dr
Naugatuck, CT 06770-5235

Mailing address

81 Wisteria Dr
Naugatuck, CT 06770-5235
Phone (203) 501-4624

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Admin@Restarthw.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220615000796 CT Part B Supplier - Clinic/Group Practice 2668851064 Receives reassigned benefits from 5 practitioners
Practice locations: Waterbury, CT

National Provider Directory

National Provider Directory

Locations

1068 W Main St
Waterbury, CT 06708
Phone (203) 518-4526

1068 W Main St
Ste 1
Waterbury, CT 06708
Phone (203) 518-4526

Interoperability endpoints

  • Direct secure messaging: admin@restarthw.com

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1645401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645401600000",
    "number": "1235884073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "81 WISTERIA DR",
            "city": "NAUGATUCK",
            "state": "CT",
            "postal_code": "067705235",
            "telephone_number": "203-501-4624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "81 WISTERIA DR",
            "city": "NAUGATUCK",
            "state": "CT",
            "postal_code": "067705235",
            "telephone_number": "203-501-4624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-21",
        "last_updated": "2022-02-21",
        "certification_date": "2022-02-21",
        "status": "A",
        "authorized_official_last_name": "MORAES",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "203-501-4624",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Admin@Restarthw.com",
            "affiliation": "N",
            "endpointDescription": "encrypted messaging",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "81 Wisteria Dr",
            "city": "Naugatuck",
            "state": "CT",
            "country_code": "US",
            "postal_code": "067705235",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Naugatuck, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.