Organization Active NPI

TMW Wellness PLLC

  • Mental Health Counselor
  • Wolcott, CT
National Provider Identifier
1912601402
Registry record updated Mar 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
TMW WELLNESS PLLC
Practice address
504 Wolcott Rd
Wolcott, CT 06716-2461
Phone
(203) 504-9507
NPI assigned
Mar 28, 2023
Organization subpart
Yes
Parent organization
THE MODERN WOMAN HEALTH & WELLNESS CENTER PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 29, 2023

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

Authorized official

Name
Shivanna Subramani-Gonzalez, FNP
Title
Cmo
Phone
(203) 725-5339

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

504 Wolcott Rd
Wolcott, CT 06716-2461

Mailing address

504 Wolcott Rd
Wolcott, CT 06716-2461

National Provider Directory

National Provider Directory
Part of
The Modern Woman Health Wellness Center PLLC

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1679961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680048000000",
    "number": "1912601402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 WOLCOTT RD",
            "city": "WOLCOTT",
            "state": "CT",
            "postal_code": "067162461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 WOLCOTT RD",
            "city": "WOLCOTT",
            "state": "CT",
            "postal_code": "067162461",
            "telephone_number": "203-504-9507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TMW WELLNESS PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE MODERN WOMAN HEALTH & WELLNESS CENTER PLLC",
        "enumeration_date": "2023-03-28",
        "last_updated": "2023-03-29",
        "certification_date": "2023-03-29",
        "status": "A",
        "authorized_official_last_name": "SUBRAMANI-GONZALEZ",
        "authorized_official_first_name": "SHIVANNA",
        "authorized_official_title_or_position": "CMO",
        "authorized_official_telephone_number": "203-725-5339",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wolcott, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2023; 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.