Healthcare Provider Details

I. General information

NPI: 1982963013
Provider Name (Legal Business Name): ZHUTA ENTERPRISES LTD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1177 HIGH RIDGE RD #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: 203-525-6496
  • Fax:
Mailing address:
  • Phone: 203-525-6496
  • 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: MENDIM ZHUTA
Title or Position: CONTACT
Credential: LMFT
Phone: 203-525-6496