Healthcare Provider Details

I. General information

NPI: 1811444771
Provider Name (Legal Business Name): RENEE EDDY LPC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 LAFAYETTE ST
NORWICH CT
06360-2708
US

IV. Provider business mailing address

119 LAFAYETTE ST
NORWICH CT
06360-2708
US

V. Phone/Fax

Practice location:
  • Phone: 860-889-0097
  • Fax: 860-889-3184
Mailing address:
  • Phone: 860-889-0097
  • Fax: 860-889-3184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number002152
License Number StateCT

VIII. Authorized Official

Name: RENEE EDDY
Title or Position: MANAGER
Credential: LPC
Phone: 860-889-0097