Olive & Oak Wellness LLC

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

Legal business name

OLIVE & OAK WELLNESS LLC

Practice address

1492 Flanders Rd
Southington, CT 06489-1604

Phone

(860) 334-7093

NPI assigned

Aug 25, 2021

Organization subpart

No

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

Authorized official

Name

Paige Fanolis, LMFT

Title

Owner

Phone

(860) 334-7093

Specialties & licenses 1

Addresses

Other names 1

• Paige Bogda, LMFT Doing business as

Electronic endpoints 1

Practitioners 1

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

• Paige Bogda, LMFT

  • Marriage & Family Therapist
  • Southington, CT
  • NPI 1447596721
  NPD

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

{
    "created_epoch": "1629849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629849600000",
    "number": "1407523764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360B QUEEN ST # 175",
            "city": "SOUTHINGTON",
            "state": "CT",
            "postal_code": "064891871",
            "telephone_number": "860-334-7093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1492 FLANDERS RD",
            "city": "SOUTHINGTON",
            "state": "CT",
            "postal_code": "064891604",
            "telephone_number": "860-334-7093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLIVE & OAK WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-25",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-25",
        "status": "A",
        "authorized_official_last_name": "FANOLIS",
        "authorized_official_first_name": "PAIGE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-334-7093",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Southington",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1492 Flanders Rd",
            "city": "Southington",
            "state": "CT",
            "country_code": "US",
            "postal_code": "064891604",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Paige Bogda, LMFT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Marriage & Family Therapist in Southington, CT
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 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.