Provider Demographics
NPI:1871952721
Name:NEW ENGLAND BALANCE AND WELLNESS, LLC
Entity type:Organization
Organization Name:NEW ENGLAND BALANCE AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BULLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC, DCC
Authorized Official - Phone:203-868-5436
Mailing Address - Street 1:15 ORMOND ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-3912
Mailing Address - Country:US
Mailing Address - Phone:203-868-5436
Mailing Address - Fax:
Practice Address - Street 1:60 CONNOLLY PKWY BLDG 12
Practice Address - Street 2:SUITE 202
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-2593
Practice Address - Country:US
Practice Address - Phone:203-868-5436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-21
Last Update Date:2016-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001538101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty