Healthcare Provider Details

I. General information

NPI: 1386372423
Provider Name (Legal Business Name): DBA SUMMIT PSYCHOTHERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 RICHMOND LN
WEST HARTFORD CT
06117-1628
US

IV. Provider business mailing address

24 RICHMOND LN
WEST HARTFORD CT
06117-1628
US

V. Phone/Fax

Practice location:
  • Phone: 860-798-8558
  • Fax: 203-283-9235
Mailing address:
  • Phone: 860-798-8558
  • Fax: 203-283-9235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: PHILIP WIENER
Title or Position: OWNER
Credential: LCSW
Phone: 860-798-8558