Provider Demographics
NPI:1114456886
Name:HAWTHORN HOLISTIC HEALTH LLC
Entity type:Organization
Organization Name:HAWTHORN HOLISTIC HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:860-759-4119
Mailing Address - Street 1:14 JENIFER LN
Mailing Address - Street 2:
Mailing Address - City:KILLINGWORTH
Mailing Address - State:CT
Mailing Address - Zip Code:06419-1459
Mailing Address - Country:US
Mailing Address - Phone:860-759-4119
Mailing Address - Fax:
Practice Address - Street 1:2969 WHITNEY AVE STE 3B
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-2556
Practice Address - Country:US
Practice Address - Phone:203-903-8624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT508175F00000X
CT503175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty