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General NPI Number Information
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NPI Number | 1134581481
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Entity Type | Organization
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Legal Business Name | GENTLE ROCK THERAPY LLC
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Dates
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Enumeration Date | 03/25/2016
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Last Update Date | 03/25/2016
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Provider Practice Location Address
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Address Line | 91 EAST AVE
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City | NORWALK
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State | CT
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Zip | 06851-5020
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Country | US
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Telephone | 203-464-3865
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Fax |
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Provider Business Mailing Address
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Address Line | 16 SHAMROCK LN
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City | NORWALK
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State | CT
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Zip | 06850-3127
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Country | US
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Telephone | 203-464-3865
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Fax |
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Authorized Official
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Title or Position | CLINICIAN
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Name | ELIZABETH GENTILE
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Credential | LCSW
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Telephone | 203-464-3865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 008306
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License Number State | CT
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