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General NPI Number Information
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NPI Number | 1194334334
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Entity Type | Organization
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Legal Business Name | COGNITIVE AND BEHAVIORAL CARE CENTER, LLC
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Dates
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Enumeration Date | 07/23/2020
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Last Update Date | 07/23/2020
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Provider Practice Location Address
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Address Line | 55 OLD POST ROAD #2, SUITE 2C
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City | GREENWICH
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State | CT
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Zip | 06830
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Country | US
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Telephone | 203-760-0044
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Fax |
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Provider Business Mailing Address
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Address Line | 3 JENIFER LN
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City | COS COB
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State | CT
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Zip | 06807-1719
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Country | US
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Telephone | 917-656-4834
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMANDA EDWARDS DOHENY
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Credential | LCSW
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Telephone | 203-760-0044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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