Provider Demographics
NPI:1770994998
Name:LITCHFIELD HILLS HEALING CENTER, LLC
Entity type:Organization
Organization Name:LITCHFIELD HILLS HEALING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:DOWNEY
Authorized Official - Last Name:ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-361-9333
Mailing Address - Street 1:232 NOTTING HILL GATE
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6066
Mailing Address - Country:US
Mailing Address - Phone:860-361-9333
Mailing Address - Fax:860-361-9334
Practice Address - Street 1:760 BANTAM ROAD
Practice Address - Street 2:
Practice Address - City:BANTAM
Practice Address - State:CT
Practice Address - Zip Code:06750
Practice Address - Country:US
Practice Address - Phone:860-361-9333
Practice Address - Fax:860-361-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-09
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001446101YM0800X, 101YP2500X
363LP0808X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008038181Medicaid