Healthcare Provider Details

I. General information

NPI: 1881130631
Provider Name (Legal Business Name): INGER SJOGREN MASTERS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 MAIN ST STE 203
WESTPORT CT
06880-3216
US

IV. Provider business mailing address

35 GRAENEST RIDGE RD
WILTON CT
06897-2929
US

V. Phone/Fax

Practice location:
  • Phone: 203-493-6557
  • Fax:
Mailing address:
  • Phone: 203-247-7563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3530
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: