Healthcare Provider Details

I. General information

NPI: 1043682818
Provider Name (Legal Business Name): THERESA LUCILLE EVANS KNIGHT MA LMFT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 CRANBURY RD
NORWALK CT
06851-2616
US

IV. Provider business mailing address

37 CRANBURY RD
NORWALK CT
06851-2616
US

V. Phone/Fax

Practice location:
  • Phone: 203-722-3312
  • Fax: 203-849-3230
Mailing address:
  • Phone: 203-722-3312
  • Fax: 203-849-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number001731
License Number StateCT

VIII. Authorized Official

Name: THERESA LUCILLE EVANS KNIGHT
Title or Position: OWNER
Credential: MA LMFT
Phone: 203-722-3312