Healthcare Provider Details

I. General information

NPI: 1710748850
Provider Name (Legal Business Name): PSYCHOTHERAPY CENTER FOR GRIEF AND HOSPICE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 NEW PARK AVE STE 120
HARTFORD CT
06106-2174
US

IV. Provider business mailing address

16 PROSPECT ST
BLOOMFIELD CT
06002-3016
US

V. Phone/Fax

Practice location:
  • Phone: 973-873-3933
  • Fax:
Mailing address:
  • Phone: 973-873-3933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: BIDOSSESSI(BIDO) E AGUESSY
Title or Position: MANAGING MEMBER
Credential: PSYD
Phone: 973-873-3933