Healthcare Provider Details

I. General information

NPI: 1740455435
Provider Name (Legal Business Name): HEIDI HENDERSON SIEBERT MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 JOHN STREET NEW LEARNING THERAPY CENTER
SOUTHPORT CT
06890-1436
US

IV. Provider business mailing address

37 SENIOR PL
FAIRFIELD CT
06825-1344
US

V. Phone/Fax

Practice location:
  • Phone: 203-307-3030
  • Fax: 203-255-7486
Mailing address:
  • Phone: 203-334-6905
  • Fax: 203-255-7486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number001250
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: