Healthcare Provider Details

I. General information

NPI: 1508264011
Provider Name (Legal Business Name): STEPHANIE OCHOA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2014
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 NEW PARK AVE STE 102
WEST HARTFORD CT
06110-1142
US

IV. Provider business mailing address

430 NEW PARK AVE STE 102
WEST HARTFORD CT
06110-1142
US

V. Phone/Fax

Practice location:
  • Phone: 844-830-7233
  • Fax:
Mailing address:
  • Phone: 844-830-7233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number011463
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7288
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-23494
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: