Healthcare Provider Details

I. General information

NPI: 1538240510
Provider Name (Legal Business Name): KELLY URBANOWICZ LMHC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 BANK ST
SEYMOUR CT
06483-2700
US

IV. Provider business mailing address

20 WANDA DR
BEACON FALLS CT
06403-1532
US

V. Phone/Fax

Practice location:
  • Phone: 203-446-7461
  • Fax: 203-463-8745
Mailing address:
  • Phone: 203-446-7461
  • Fax: 203-463-8745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC00169
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number002187
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: