Healthcare Provider Details

I. General information

NPI: 1245708189
Provider Name (Legal Business Name): SMPSYCHOTHERAPY & COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MILL PLAIN RD FL 3
DANBURY CT
06811-5189
US

IV. Provider business mailing address

168 PRIVILEGE RD
BLOOMFIELD CT
06002-1999
US

V. Phone/Fax

Practice location:
  • Phone: 203-800-9778
  • Fax:
Mailing address:
  • Phone: 203-800-9778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. SORIBEL MARTINEZ
Title or Position: OWNER
Credential: LCSW
Phone: 203-558-1074