Healthcare Provider Details

I. General information

NPI: 1740603349
Provider Name (Legal Business Name): FAMILY REENTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 MOTT AVE
NORWALK CT
06850-3330
US

IV. Provider business mailing address

9 MOTT AVE
NORWALK CT
06850-3330
US

V. Phone/Fax

Practice location:
  • Phone: 203-838-0496
  • Fax: 203-866-9291
Mailing address:
  • Phone: 203-838-0496
  • Fax: 203-866-9291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: STEVE LANZA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 203-838-0496