Healthcare Provider Details

I. General information

NPI: 1518494202
Provider Name (Legal Business Name): SINGLE STEP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 12/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 MAIN ST
MIDDLETOWN CT
06457-3359
US

IV. Provider business mailing address

363 MAIN ST
MIDDLETOWN CT
06457-3359
US

V. Phone/Fax

Practice location:
  • Phone: 860-759-3926
  • Fax: 203-439-2087
Mailing address:
  • Phone: 860-759-3926
  • Fax: 203-439-2087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JANICE KEEMAN
Title or Position: OWNER
Credential: LCSW
Phone: 860-759-3926