Provider Demographics
NPI:1447643788
Name:SYNERGY PSYCHOTHERAPY, LLC
Entity type:Organization
Organization Name:SYNERGY PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLBER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-207-5567
Mailing Address - Street 1:10 FORT HILL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-4760
Mailing Address - Country:US
Mailing Address - Phone:860-207-5575
Mailing Address - Fax:860-415-8385
Practice Address - Street 1:10 FORT HILL RD STE 1
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-4760
Practice Address - Country:US
Practice Address - Phone:860-207-5575
Practice Address - Fax:860-415-8385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0088881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty