Healthcare Provider Details

I. General information

NPI: 1902022361
Provider Name (Legal Business Name): NEW LEARNING THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 JOHN ST SUITE 102
SOUTHPORT CT
06890-1436
US

IV. Provider business mailing address

49 JOHN ST SUITE 102
SOUTHPORT CT
06890-1436
US

V. Phone/Fax

Practice location:
  • Phone: 203-307-3030
  • Fax: 203-255-7486
Mailing address:
  • Phone: 203-307-3030
  • Fax: 203-255-7486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number001785
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002652
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000015
License Number StateCT

VIII. Authorized Official

Name: KAREN MORETTI
Title or Position: DIR OF BUSINESS OPERATIONS
Credential:
Phone: 203-307-3030