Healthcare Provider Details

I. General information

NPI: 1114393493
Provider Name (Legal Business Name): KEY THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 MAIN ST STE 122
MONROE CT
06468-2872
US

IV. Provider business mailing address

13 ROOSEVELT DR
NEWTOWN CT
06470-2035
US

V. Phone/Fax

Practice location:
  • Phone: 203-261-7090
  • Fax: 888-856-3413
Mailing address:
  • Phone: 203-300-6414
  • Fax: 888-856-3413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number001736
License Number StateCT

VIII. Authorized Official

Name: MRS. SAMANTHA LEE BIRTWELL
Title or Position: LMFT
Credential: MA
Phone: 203-300-6414