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General NPI Number Information
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NPI Number | 1154234227
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Entity Type | Organization
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Legal Business Name | BLUE ARCH LLC
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Dates
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Enumeration Date | 09/28/2026
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 4 LONG RIDGE RD FL 3
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City | REDDING
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State | CT
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Zip | 06896-1111
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Country | US
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Telephone | 646-226-7306
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Fax |
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Provider Business Mailing Address
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Address Line | 28 1ST ST
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City | STAMFORD
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State | CT
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Zip | 06905-5117
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Country | US
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Telephone | 646-226-7306
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LINA LEE
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Credential |
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Telephone | 646-226-7306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State | NULL
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