Healthcare Provider Details

I. General information

NPI: 1336565316
Provider Name (Legal Business Name): NORA J GUMPEL LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 LINCOLN AVE
PAWCATUCK CT
06379-1857
US

IV. Provider business mailing address

78 FRONT ST
GROTON CT
06340-5750
US

V. Phone/Fax

Practice location:
  • Phone: 914-204-4396
  • Fax:
Mailing address:
  • Phone: 914-204-4396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number001655
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: