Healthcare Provider Details

I. General information

NPI: 1235745407
Provider Name (Legal Business Name): MILISSA SCHRAMM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 EAST AVE
NORWALK CT
06851-5703
US

IV. Provider business mailing address

53 OLD DAM RD
FAIRFIELD CT
06824-6386
US

V. Phone/Fax

Practice location:
  • Phone: 203-750-9711
  • Fax:
Mailing address:
  • Phone: 203-521-5598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: