Healthcare Provider Details

I. General information

NPI: 1205762143
Provider Name (Legal Business Name): MOON POPPY PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 FENWICK DR
FARMINGTON CT
06032-1436
US

IV. Provider business mailing address

20 FENWICK DR
FARMINGTON CT
06032-1436
US

V. Phone/Fax

Practice location:
  • Phone: 203-918-6267
  • Fax:
Mailing address:
  • Phone: 203-918-6267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE PHILLIPS
Title or Position: FOUNDER
Credential: LMFT
Phone: 203-918-6267