Healthcare Provider Details

I. General information

NPI: 1043829195
Provider Name (Legal Business Name): AMY CAVE, LMFT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 11/20/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 MOHAWK DR
WALLINGFORD CT
06492-2808
US

IV. Provider business mailing address

4 S MAIN ST UNIT 841
WALLINGFORD CT
06492-7734
US

V. Phone/Fax

Practice location:
  • Phone: 860-941-6159
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AMY CAVE
Title or Position: OWNER
Credential: LMFT
Phone: 860-941-6159