Healthcare Provider Details

I. General information

NPI: 1346590189
Provider Name (Legal Business Name): HEATHER LEA GLENNEY ZIEMBA PHD, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER LEA GLENNEY PHD, LPC

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 LAFAYETTE ST.
NORWICH CT
06360
US

IV. Provider business mailing address

119 LAFAYETTE ST.
NORWICH CT
06360
US

V. Phone/Fax

Practice location:
  • Phone: 860-889-0097
  • Fax: 860-822-6672
Mailing address:
  • Phone: 860-889-0097
  • Fax: 860-822-6672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number002235
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number002235
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: