Healthcare Provider Details

I. General information

NPI: 1194576629
Provider Name (Legal Business Name): TAYLOR SAGAN LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 MAIN ST
NEW BRITAIN CT
06051-4204
US

IV. Provider business mailing address

87 DUNHAM ST
SOUTHINGTON CT
06489-1219
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-8192
  • Fax:
Mailing address:
  • Phone: 860-770-4508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number7082
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: