Healthcare Provider Details

I. General information

NPI: 1013870245
Provider Name (Legal Business Name): LYCIA THERAPY LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1058 PECK LN
CHESHIRE CT
06410-1531
US

IV. Provider business mailing address

1058 PECK LN
CHESHIRE CT
06410-1531
US

V. Phone/Fax

Practice location:
  • Phone: 475-303-5494
  • Fax: 475-275-7227
Mailing address:
  • Phone: 475-303-5494
  • Fax: 475-275-7227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SELIN KELLY
Title or Position: PSYCHOTHERAPIST
Credential: LCSW
Phone: 917-809-0726