MEDICARE: GWENDOLYN WORKMAN LMFT

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	00746	CT

General Provider Information

NPI Number	:	1548399850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENDOLYN WORKMAN LMFT

Provider Business Mailing Address
First Line	:	1 BRADLEY RD
Second Line	:	SUITE 903
City	:	WOODBRIDGE
State	:	CT
Zip	:	06525-2285
Country	:	US
Telephone Number	:	203-397-0653
Fax Number	:	203-288-1014

Provider Business Practice Location Address
First Line	:	1 BRADLEY RD
Second Line	:	SUITE 903
City	:	WOODBRIDGE
State	:	CT
Zip	:	06525-2285
Country	:	US
Telephone Number	:	203-397-0653
Fax Number	:	203-288-1014

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2007
Last Update Date	:	07/09/2007

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Directions to “ GWENDOLYN WORKMAN LMFT” Practice Location

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