Healthcare Provider Details

I. General information

NPI: 1720348519
Provider Name (Legal Business Name): STEPHANIE LOEB BEILINSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 SOUTH AVE
BRIDGEPORT CT
06604-5810
US

IV. Provider business mailing address

17 ANN ST
TRUMBULL CT
06611-1955
US

V. Phone/Fax

Practice location:
  • Phone: 203-332-3154
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number002543
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: