Healthcare Provider Details

I. General information

NPI: 1265721195
Provider Name (Legal Business Name): MENDIM ZHUTA LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1177 HIGH RIDGE RD SUITE #120
STAMFORD CT
06905-1221
US

IV. Provider business mailing address

8 WEAVER ST L1R
GREENWICH CT
06831-5129
US

V. Phone/Fax

Practice location:
  • Phone: 203-318-4438
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number001321
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: