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NPI Code Detail

MEDICARE: FARMINGTON VALLEY COUNSELING CENTER LLC

MEDICARE: FARMINGTON VALLEY COUNSELING CENTER 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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1548734791
Entity Type Code : Organization
Provider Name (Legal Business Name) : FARMINGTON VALLEY COUNSELING CENTER LLC
Provider Business Mailing Address
First Line : 111 SIMSBURY RD STE 104
Second Line :
City : AVON
State : CT
Zip : 06001-3763
Country : US
Telephone Number : 860-255-4017
Fax Number :
Provider Business Practice Location Address
First Line : 111 SIMSBURY RD STE 104
Second Line :
City : AVON
State : CT
Zip : 06001-3763
Country : US
Telephone Number : 860-255-4017
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER
Name : MARLA DAKIN
Credential : LCSW
Telephone Number : 860-255-4017
Provider Enumeration Date : 01/21/2019
Last Update Date : 07/20/2020

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Directions to “FARMINGTON VALLEY COUNSELING CENTER LLC ” Practice Location

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