=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104387091
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARGARITA M COSSUTO PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2019
-----------------------------------------------------
Last Update Date | 10/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1720 POST RD E STE 223
-----------------------------------------------------
City | WESTPORT
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06880-5643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-220-6486
-----------------------------------------------------
Fax | 203-220-6487
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 46 LAKEVIEW DR
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06850-2018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-451-7880
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 4902
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------