1083113872 NPI number — WHOLEPERSON THERAPEUTICS LLC

Table of content: (NPI 1336580422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083113872 NPI number — WHOLEPERSON THERAPEUTICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHOLEPERSON THERAPEUTICS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083113872
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 ELIZABETH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DERBY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06418-1835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-636-0065
Provider Business Mailing Address Fax Number:
203-399-0006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 ELIZABETH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DERBY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06418-1835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-636-0065
Provider Business Practice Location Address Fax Number:
203-399-0006
Provider Enumeration Date:
02/07/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BELICIA
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
JOANNA
Authorized Official Title or Position:
OWNER - THERAPIST
Authorized Official Telephone Number:
203-636-0065

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XN1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0019X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1200590 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 068560 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1158567 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1284635 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1284635 . This is a "ANTHEM BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 627714200 . This is a "OWCP" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 068560 . This is a "MEDRISK" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 20005664 . This is a "HAVARD PILGRIM" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 8078763 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8078938 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3812947 . This is a "WELLCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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