Southbury Wellness Center, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

SOUTHBURY WELLNESS CENTER, LLC

Practice address

2 Pomperaug Office Park Ste 206
Southbury, CT 06488-2291

Phone

(203) 915-7688

NPI assigned

Oct 20, 2021

Organization subpart

No

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

Authorized official

Name

Rebecha Sullivan, LCSWNPI 1255641072

Title

Owner/Member

Phone

(203) 915-7688

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

Practitioners 1

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

• Rebecha Kay Sullivan, LCSW

  • Clinical Social Worker
  • Southbury, CT
  • NPI 1255641072
  NPD Authorized official

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

{
    "created_epoch": "1634688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634688000000",
    "number": "1508529173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 TIMBERLAND DR",
            "city": "SOUTHBURY",
            "state": "CT",
            "postal_code": "064881170",
            "telephone_number": "203-915-7688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 POMPERAUG OFFICE PARK STE 206",
            "city": "SOUTHBURY",
            "state": "CT",
            "postal_code": "064882291",
            "telephone_number": "203-915-7688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHBURY WELLNESS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-20",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-20",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "REBECHA",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "203-915-7688",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255641072",
            "state": "CT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "southburywellnesscenter@gmail.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "2 Pomperaug Office Park Ste 206",
            "city": "Southbury",
            "state": "CT",
            "country_code": "US",
            "postal_code": "064882291",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Southbury Medical Associates, LLP
• Southbury Physical Therapy
• Southbury Senior Living, LLC
• Southbury Smiles, LLC
• Southbury Sports and Spine Chiropractic LLC
• Southbury-Middlebury Youth & Family Serv
• Southbury-Middlebury Youth & Family Services
• Southbury-Middlebury Youth and Family Services
• Jaiden Souza
• Marlene Spahr

• Community/Behavioral Health Agency in Southbury, CT
• Providers in Southbury, CT by specialty
• Community/Behavioral Health Agency in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 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.