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General NPI Number Information
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NPI Number | 1134406887
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Entity Type | Organization
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Legal Business Name | WAVERLY GROUP
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Dates
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Enumeration Date | 11/09/2011
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Last Update Date | 11/09/2011
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Provider Practice Location Address
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Address Line | 100 MELROSE AVE SUITE 100
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City | GREENWICH
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State | CT
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Zip | 06830-6257
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Country | US
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Telephone | 203-622-8600
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Fax | 203-622-1760
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Provider Business Mailing Address
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Address Line | 100 MELROSE AVE SUITE 100
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City | GREENWICH
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State | CT
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Zip | 06830-6257
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Country | US
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Telephone | 203-622-8600
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Fax | 203-622-1760
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Authorized Official
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Title or Position | MEMBER/MANAGING DIRECTOR
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Name | LAUREN ZALIS
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Credential | OTR/L
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Telephone | 203-622-8600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 001840
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 003422
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License Number State | CT
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