Healthcare Provider Details

I. General information

NPI: 1114557998
Provider Name (Legal Business Name): EMILY ANN MOKLER MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMMA ANN MOKLER MFT

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 11/27/2023
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 W MAIN ST
NIANTIC CT
06357-2303
US

IV. Provider business mailing address

8 W MAIN ST STE 3-15
NIANTIC CT
06357-2332
US

V. Phone/Fax

Practice location:
  • Phone: 978-810-2476
  • Fax:
Mailing address:
  • Phone: 860-451-9364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2345
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: