Healthcare Provider Details

I. General information

NPI: 1528322773
Provider Name (Legal Business Name): AUDETTE & ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MAIN ST SUITE 813
STAMFORD CT
06901-3004
US

IV. Provider business mailing address

400 MAIN ST SUITE 800
STAMFORD CT
06901-3004
US

V. Phone/Fax

Practice location:
  • Phone: 203-733-5953
  • Fax: 203-733-5953
Mailing address:
  • Phone: 203-733-5953
  • Fax: 203-733-5953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ALBERT DAVID AUDETTE JR.
Title or Position: OWNER
Credential: MS
Phone: 203-733-5953