Healthcare Provider Details

I. General information

NPI: 1477037661
Provider Name (Legal Business Name): PSYCHOTHERAPY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 CHURCH STREET
NEW PRESTON CT
06777
US

IV. Provider business mailing address

25 EAST SHORE RD
NEW PRESTON CT
06777-1619
US

V. Phone/Fax

Practice location:
  • Phone: 860-307-0954
  • Fax:
Mailing address:
  • Phone: 860-307-0954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ELIZABETH MCMULLAN
Title or Position: PSYCHOTHERAPIST
Credential: LCSW
Phone: 860-307-0954