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General NPI Number Information
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NPI Number | 1114127636
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Entity Type | Organization
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Legal Business Name | THE FAMILY ROOM, LLC
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 07/23/2007
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Provider Practice Location Address
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Address Line | 31 CHERRY ST 2ND FLOOR, FRONT
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City | MILFORD
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State | CT
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Zip | 06460-3414
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Country | US
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Telephone | 203-522-4554
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Fax | 203-413-1587
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Provider Business Mailing Address
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Address Line | 1015 CHAPEL ST
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City | STRATFORD
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State | CT
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Zip | 06614-1644
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Country | US
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Telephone | 203-522-4554
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Fax | 203-413-1587
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Authorized Official
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Title or Position | PARTNER
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Name | ANNMARIE CARSON
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Credential | LMFT
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Telephone | 203-522-4554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 001151
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License Number State | CT
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