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General NPI Number Information
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NPI Number | 1013870245
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Entity Type | Organization
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Legal Business Name | LYCIA THERAPY LLC.
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Dates
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Enumeration Date | 12/04/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 1058 PECK LN
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City | CHESHIRE
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State | CT
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Zip | 06410-1531
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Country | US
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Telephone | 475-303-5494
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Fax | 475-275-7227
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Provider Business Mailing Address
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Address Line | 1058 PECK LN
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City | CHESHIRE
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State | CT
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Zip | 06410-1531
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Country | US
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Telephone | 475-303-5494
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Fax | 475-275-7227
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | SELIN KELLY
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Credential | LCSW
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Telephone | 917-809-0726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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