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General NPI Number Information
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NPI Number | 1063052355
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Entity Type | Organization
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Legal Business Name | KEYS PROGRAM INC
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Dates
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Enumeration Date | 01/14/2020
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 90 BRAINARD RD STE 105
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City | HARTFORD
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State | CT
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Zip | 06114-1687
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Country | US
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Telephone | 860-404-5501
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Fax | 860-470-3286
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Provider Business Mailing Address
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Address Line | 90 BRAINARD RD STE 105
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City | HARTFORD
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State | CT
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Zip | 06114-1687
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Country | US
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Telephone | 860-404-5501
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Fax | 860-470-3286
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. CORTNEY DUNLAP
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Credential | ED.D
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Telephone | 860-404-5501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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