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General NPI Number Information
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NPI Number | 1114393493
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Entity Type | Organization
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Legal Business Name | KEY THERAPY LLC
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Dates
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Enumeration Date | 08/20/2015
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Last Update Date | 07/24/2020
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Provider Practice Location Address
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Address Line | 731 MAIN ST STE 122
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City | MONROE
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State | CT
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Zip | 06468-2872
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Country | US
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Telephone | 203-261-7090
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Fax | 888-856-3413
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Provider Business Mailing Address
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Address Line | 13 ROOSEVELT DR
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City | NEWTOWN
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State | CT
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Zip | 06470-2035
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Country | US
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Telephone | 203-300-6414
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Fax | 888-856-3413
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Authorized Official
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Title or Position | LMFT
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Name | MRS. SAMANTHA LEE BIRTWELL
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Credential | MA
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Telephone | 203-300-6414
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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 | 001736
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License Number State | CT
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