Provider Demographics
NPI:1588300271
Name:ALIS VOLAT PROPRIIS PLACE, LLC
Entity type:Organization
Organization Name:ALIS VOLAT PROPRIIS PLACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDING MEMBER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-232-5887
Mailing Address - Street 1:705 BOSTON POST RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2744
Mailing Address - Country:US
Mailing Address - Phone:203-293-2005
Mailing Address - Fax:
Practice Address - Street 1:705 BOSTON POST RD STE 2A
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2744
Practice Address - Country:US
Practice Address - Phone:203-293-2005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty