Healthcare Provider Details

I. General information

NPI: 1144638263
Provider Name (Legal Business Name): MARIA A GORBY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 08/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ACADEMY HILL RD
PLAINFIELD CT
06374-1600
US

IV. Provider business mailing address

50 ACADEMY HILL RD
PLAINFIELD CT
06374-1600
US

V. Phone/Fax

Practice location:
  • Phone: 860-564-2323
  • Fax: 860-564-2696
Mailing address:
  • Phone: 860-564-2323
  • Fax: 860-564-2696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000247
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: