Healthcare Provider Details

I. General information

NPI: 1346525961
Provider Name (Legal Business Name): CHERI ANNE RIVARD-LENTZ LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 PENDLETON DR
HEBRON CT
06248-1525
US

IV. Provider business mailing address

25 PENDLETON DR
HEBRON CT
06248-1525
US

V. Phone/Fax

Practice location:
  • Phone: 860-228-9488
  • Fax:
Mailing address:
  • Phone: 860-228-9488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000954
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: