Healthcare Provider Details

I. General information

NPI: 1912642877
Provider Name (Legal Business Name): BURCU ALTINTAS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 MAIN ST S STE B2
WOODBURY CT
06798-3738
US

IV. Provider business mailing address

90 UNION AVE
WEST HAVEN CT
06516-5048
US

V. Phone/Fax

Practice location:
  • Phone: 203-263-3175
  • Fax:
Mailing address:
  • Phone: 631-942-2660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5529
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: