Healthcare Provider Details

I. General information

NPI: 1194232637
Provider Name (Legal Business Name): FAMILYLINK COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 01/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 MONROE TPKE STE 3
TRUMBULL CT
06611-6351
US

IV. Provider business mailing address

69 COTTAGE ST
TRUMBULL CT
06611-2827
US

V. Phone/Fax

Practice location:
  • Phone: 914-980-4724
  • Fax:
Mailing address:
  • Phone: 914-980-4724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. COURTNEY MARIE MATTIACE
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 914-980-4724