Healthcare Provider Details

I. General information

NPI: 1548339542
Provider Name (Legal Business Name): DONALD P. OPATRNY LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 MAIN ST STE 2 ASPETUCK COUNSELING CENTER
MONROE CT
06468
US

IV. Provider business mailing address

34 HERITAGE DR
SEYMOUR CT
06483-3847
US

V. Phone/Fax

Practice location:
  • Phone: 203-452-0399
  • Fax: 203-452-0399
Mailing address:
  • Phone: 203-233-9179
  • Fax: 203-452-0399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number001051
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: