Healthcare Provider Details

I. General information

NPI: 1942446141
Provider Name (Legal Business Name): AIMEE BLIVEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AIMEE CLARK

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 VAUXHALL ST
NEW LONDON CT
06320
US

IV. Provider business mailing address

23 SUNSET AVE
LEDYARD CT
06339-1040
US

V. Phone/Fax

Practice location:
  • Phone: 860-442-2797
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5771
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: