Provider Demographics
NPI:1588283378
Name:STARS OF LOVE AND LIGHT
Entity type:Organization
Organization Name:STARS OF LOVE AND LIGHT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH CLINCIAN
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TEXIDOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-241-1662
Mailing Address - Street 1:34 BARKER RD
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-4902
Mailing Address - Country:US
Mailing Address - Phone:203-240-1662
Mailing Address - Fax:
Practice Address - Street 1:125 GREENWOOD AVE PH 2ND
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-2586
Practice Address - Country:US
Practice Address - Phone:203-240-1662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-11
Last Update Date:2020-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty