LIFESOURCE OF NORTH CAROLINA (NPI# 1972131308) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972131308 |
| Entity Type | Organization |
| Organization Name | LIFESOURCE OF NORTH CAROLINA |
| Practice Address |
140 Park Ave Bloomfield CT 06002-3207 |
| Mailing Address |
Po Box 538622 Atlanta GA 30353-8622 |
| Practice Telephone | 9107429243 |
| Practice Fax Number | 8887461787 |
| Mailing Telephone | 9107429243 |
| Mailing Fax Number | 8887461787 |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2020-03-31 |
| Authorized Official Name | PEGGY BADDOUR (PRESIDENT) |
| Authorized Official Telephone | 9105351211 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TC0700X |
Psychologist Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497378848 | Lifesource of North Carolina | Psychologist | 8315 Zimpel St, New Orleans, LA 70118-1169 | 2020-05-20 |
| 1649877762 | Lifesource of North Carolina | Psychologist | 501 2nd St, Menominee, MI 49858-3203 | 2020-10-01 |
| 1619515277 | Lifesource of North Carolina | Psychologist | 204 W Main St, New London, OH 44851-1070 | 2019-12-13 |
| 1801431127 | Lifesource of North Carolina | Psychologist | 725 2nd Ave S, Hopkins, MN 55343-7782 | 2019-11-11 |
| 1174168496 | Lifesource of North Carolina | Psychologist | 600 Main St S, Minot, ND 58701-4499 | 2019-11-11 |
| 1801431440 | Lifesource of North Carolina | Psychologist | 1728 W 8th St, Cedar Falls, IA 50613-2002 | 2019-11-07 |
| 1093350647 | Lifesource of North Carolina | Psychologist | 2900 W E St, North Platte, NE 69101-1803 | 2019-11-07 |
| 1871135723 | Lifesource of North Carolina | Psychologist | 3540 S 43rd St, Milwaukee, WI 53220-1502 | 2019-10-11 |
| 1538728183 | Lifesource of North Carolina | Psychologist | 200 Nursing Home Ln, Pikeville, KY 41501-6896 | 2019-06-07 |
| 1730648288 | Lifesource of North Carolina | Social Worker | 5530 Northrop Rd, Milton, FL 32570-8701 | 2019-03-14 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | LifeSource of North Carolina Inc. | 5617 Maxwell Place, Wilmington, North Carolina 28408 |
| Alabama Business Registrations | LifeSource of North Carolina, Inc. | 5617 Maxwell Place, Wilmington, NC 28409 |
| Street Address |
140 PARK AVE |
| City | BLOOMFIELD |
| State | CT |
| Zip Code | 06002-3207 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083190243 | Sylwia Tuesta | Registered Nurse | 140 Park Ave, Bloomfield, CT 06002-3207 | 2018-07-11 |
| 1659439057 | Wintonbury Care Center LLC | Skilled Nursing Facility | 140 Park Ave, Bloomfield, CT 06002-3207 | 2006-12-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558908897 | Duncaster, Inc. | Clinic/Center | 30 Loeffler Rd., Bloomfield, CT 06002 | 2019-12-05 |
| 1104467919 | Caroline Suzanne Carey Oesch | Counselor | 71 West Dudley St, Bloomfield, CT 06002 | 2019-10-02 |
| 1679047534 | Inspire Me, LLC | Counselor | 1-2 Camelot Drive, Bloomfield, CT 06002 | 2019-01-14 |
| 1508348947 | Rebecca Perry | Student in an Organized Health Care Education/Training Program | 693 Bloomfield Avenue, Bloomfield, CT 06002 | 2018-09-01 |
| 1760996946 | Monique Edwards | Social Worker | 705 New Briatin Ave, Chd, Bloomfield, CT 06002 | 2017-11-27 |
| 1225564412 | Merva E Dixon | Nurse Practitioner | 38 Hill Farm Rd, Bloomfield, CT 06002 | 2017-05-07 |
| 1538602610 | Jaime Acevedo | Counselor | 571 Bloomfield Ave, Bloomfield, CT 06002 | 2016-11-22 |
| 1669835138 | Jacob Badura | Pharmacist | 799-824 Park Ave, Bloomfield, CT 06002 | 2016-04-01 |
| 1316283328 | Julie Jason Farrelly | Counselor | 45 Wintonbury Ave Ste 102, Bloomfield, CT 06002 | 2012-12-19 |
| 1184915860 | Rachel Benedetto Scott | Surgery | 6 Northwestern Drive, Suite 305, Bloomfield, CT 06002 | 2011-04-28 |
| Find all providers in zip 06002 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750981312 | Kylie Cleesattel | Social Worker | 37 Maple St Fl 2, Bloomfield, NJ 07003-3601 | 2020-10-31 |
| 1174155907 | Talk Therapy LLC | Social Worker | 10 Cyrus Ln, Bloomfield, CT 06002-3042 | 2020-02-10 |
| 1629608856 | Saraphina Mwangi | Social Worker | 34 Jerome Ave Ste 218, Bloomfield, CT 06002-2463 | 2020-01-15 |
| 1639726284 | Shiloh O Waldron | Social Worker | 186 Sylvan Rd, Bloomfield, NJ 07003-5543 | 2019-08-19 |
| 1700430758 | Anne Elise Phillips | Social Worker | 5507 Farmers Ln, Bloomfield, MI 48301-1108 | 2019-07-29 |
| 1861052797 | Be The Light LLC | Social Worker | 202 Bloomfield Ave Apt 309, Bloomfield, NJ 07003-5790 | 2019-06-13 |
| 1124584982 | A Tree of Life Counseling Center | Social Worker | 3 Barnard Ln Ste 310, Bloomfield, CT 06002-2495 | 2019-02-18 |
| 1144709239 | Jennifer Stuart | Social Worker | 27 Park Place, Apt. 13, Bloomfield, NJ 07003 | 2018-08-09 |
| 1356834618 | Ntw Behavioral Health Services LLC | Social Worker | 50 Jackson Rd, Bloomfield, CT 06002-3927 | 2018-06-12 |
| 1336639442 | Cambridge Mental Health, LLC | Social Worker | 71 W Dudley Town Rd, Bloomfield, CT 06002-5308 | 2018-05-14 |
| Find all providers in BLOOMFIELD | ||||
| City | BLOOMFIELD |
| Zip Code | 06002 |
Please comment or provide details below to improve the information on LIFESOURCE OF NORTH CAROLINA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.