Healthcare Provider Details

I. General information

NPI: 1114082310
Provider Name (Legal Business Name): TEMENOS INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 EAST MAIN STREET
WESTPORT CT
06880
US

IV. Provider business mailing address

29 EAST MAIN STREET
WESTPORT CT
06880
US

V. Phone/Fax

Practice location:
  • Phone: 203-227-4388
  • Fax: 203-227-3710
Mailing address:
  • Phone: 203-227-4388
  • Fax: 203-227-3710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberC-0116
License Number StateCT

VIII. Authorized Official

Name: DR. JOSEPH PAUL WAGENSELLER
Title or Position: PRESIDENT
Credential: DMIN LPC NC PSYA LP
Phone: 203-226-6725