Healthcare Provider Details

I. General information

NPI: 1316836976
Provider Name (Legal Business Name): HEATHER NICOLE REPKO-MOSES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 DANBURY RD STE 202
RIDGEFIELD CT
06877-4148
US

IV. Provider business mailing address

14 SOUTH ST UNIT 42
DANBURY CT
06810-8183
US

V. Phone/Fax

Practice location:
  • Phone: 203-403-3490
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7478
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: