Healthcare Provider Details

I. General information

NPI: 1184548182
Provider Name (Legal Business Name): MANUELITA PAYEN LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 WELLS ST APT 5
BRIDGEPORT CT
06606-5457
US

IV. Provider business mailing address

335 WELLS ST APT 5
BRIDGEPORT CT
06606-5457
US

V. Phone/Fax

Practice location:
  • Phone: 401-829-9953
  • Fax:
Mailing address:
  • Phone: 401-829-9953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: