Watertown Wellness Center LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

003013 Issued in CT

Legal business name

WATERTOWN WELLNESS CENTER LLC

Practice address

116 Georgetown Drive
Watertown, CT 06795

Phone

(203) 592-7898

NPI assigned

Apr 17, 2018

Organization subpart

No

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

Authorized official

Name

Laura Anne Manderino, LPCNPI 1780946574

Title

Owner/Licensed Psychotherapist

Phone

(203) 592-7898

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Laura Anne Manderino, M.A.

  • Counselor
  • Oakville, CT
  • NPI 1780946574
  NPD (past) Authorized official

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

{
    "created_epoch": "1523923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523923200000",
    "number": "1396232187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 GEORGETOWN DR",
            "city": "WATERTOWN",
            "state": "CT",
            "postal_code": "067953349",
            "telephone_number": "203-592-7898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 GEORGETOWN DRIVE",
            "city": "WATERTOWN",
            "state": "CT",
            "postal_code": "06795",
            "telephone_number": "203-592-7898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERTOWN WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-17",
        "last_updated": "2018-04-17",
        "status": "A",
        "authorized_official_last_name": "MANDERINO",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "OWNER/LICENSED PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "203-592-7898",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "CT",
            "license": "003013",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co
• Colleen Warner, MAATC, LPC-A
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• Waterbury Extended Care Facility, Inc.
• Watertown Board of Education
• Waterview Counseling Services LLC
• Jody-Ann Weise, LMSW
• Sheila Whitman, LPC
• Ann-Marie Williams, PA-C
• Lauren Elizabeth Williams, COTA/L

• Professional Counselor in Watertown, CT
• Providers in Watertown, CT by specialty
• Professional Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2018; 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.