Provider Demographics
NPI:1124907530
Name:RE-ENVISIONED LIFE CLINICAL SERVICES LLC
Entity type:Organization
Organization Name:RE-ENVISIONED LIFE CLINICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN-MARIE
Authorized Official - Middle Name:ATIYAH
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC MMFT MMHC
Authorized Official - Phone:860-816-2311
Mailing Address - Street 1:213 WINDSOR AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-4540
Mailing Address - Country:US
Mailing Address - Phone:860-816-2311
Mailing Address - Fax:
Practice Address - Street 1:213 WINDSOR AVE FL 1
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-4540
Practice Address - Country:US
Practice Address - Phone:860-816-2311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty