Provider Demographics
NPI:1942020235
Name:SPIRIT SOUL AND BODY CLINICAL SERVICES
Entity type:Organization
Organization Name:SPIRIT SOUL AND BODY CLINICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASTER SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:860-881-1347
Mailing Address - Street 1:303 ARCH ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-2520
Mailing Address - Country:US
Mailing Address - Phone:860-964-7311
Mailing Address - Fax:
Practice Address - Street 1:303 ARCH ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-2520
Practice Address - Country:US
Practice Address - Phone:860-964-7311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-12
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty