MEDICARE: ART OF THERAPY, LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	001227	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134513062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ART OF THERAPY, LLC.

Provider Business Mailing Address
First Line	:	925 SULLIVAN AVE
Second Line	:	UNIT 2
City	:	SOUTH WINDSOR
State	:	CT
Zip	:	06074-2025
Country	:	US
Telephone Number	:	860-432-7771
Fax Number	:

Provider Business Practice Location Address
First Line	:	925 SULLIVAN AVE
Second Line	:	UNIT 2
City	:	SOUTH WINDSOR
State	:	CT
Zip	:	06074-2025
Country	:	US
Telephone Number	:	860-432-7771
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STACEY HANSEN
Credential	:	LMFT
Telephone Number	:	860-214-4695

Provider Enumeration Date	:	03/28/2015
Last Update Date	:	07/01/2015

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Directions to “ART OF THERAPY, LLC. ” Practice Location

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