Healthcare Provider Details

I. General information

NPI: 1346777265
Provider Name (Legal Business Name): DW BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 05/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 PST ROAD EAST 205
WESTPORT CT
06880
US

IV. Provider business mailing address

18 RANSON ST FRNT
STAMFORD CT
06902-6132
US

V. Phone/Fax

Practice location:
  • Phone: 917-991-8566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DEBRA WOLKENFELD
Title or Position: PSYCHOTHERAPIST
Credential: PH.D.
Phone: 917-991-8566