Healthcare Provider Details

I. General information

NPI: 1336043348
Provider Name (Legal Business Name): BROOKE ELIZABETH HERON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 COMMONS PARK S UNIT 612
STAMFORD CT
06902-7066
US

IV. Provider business mailing address

92 GALLOWS HILL RD
REDDING CT
06896-1409
US

V. Phone/Fax

Practice location:
  • Phone: 203-219-0225
  • Fax:
Mailing address:
  • Phone: 203-219-0225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10154
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: