Healthcare Provider Details

I. General information

NPI: 1366884249
Provider Name (Legal Business Name): GALVAN HENKIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 TODDS WAY
WESTPORT CT
06880-5645
US

IV. Provider business mailing address

4 TODDS WAY
WESTPORT CT
06880-5645
US

V. Phone/Fax

Practice location:
  • Phone: 203-255-2680
  • Fax:
Mailing address:
  • Phone: 203-255-2680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANITA SANDRA GALVAN-HENKIN
Title or Position: MEMBER
Credential: LCSW
Phone: 203-255-2680