Kellie Eagle, LMSW

Individual provider Active NPI Case Manager/Care Coordinator · Bozrah, CT

NPI 1902205172 · NPPES record last updated Sep 9, 2021

Key facts

NPI
1902205172
Entity type
Individual (NPI type 1)
Primary specialty
Case Manager/Care Coordinator 171M00000X
Practice address
28 Haughton Rd
Bozrah, CT 06334-1207
Phone
(860) 917-0790
Fax
(608) 371-2624
NPI assigned
Aug 14, 2014
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
Inner Peace CT Past
since Sep 12, 2021
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X Yes

Addresses

Primary practice location

28 Haughton Rd
Bozrah, CT 06334-1207

Mailing address

191 Spicer Hill Rd
Ledyard, CT 06339-1535
Phone (860) 917-0790

Other providers in Bozrah, CT

All providers in Bozrah, CT · Case Manager/Care Coordinator in Connecticut

Sources for this page

Verify at the official NPI Registry.