Provider Demographics
NPI:1902574940
Name:THERAPEUTIC RESOLUTION LLC
Entity Type:Organization
Organization Name:THERAPEUTIC RESOLUTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-552-7811
Mailing Address - Street 1:1 FORT HILL RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-4799
Mailing Address - Country:US
Mailing Address - Phone:860-552-7811
Mailing Address - Fax:
Practice Address - Street 1:1057 POQUONNOCK RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-6630
Practice Address - Country:US
Practice Address - Phone:860-552-7811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-03
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty