=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225368913
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JENNY ALZATE LPC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2010
-----------------------------------------------------
Last Update Date | 01/14/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 78 CAMBRIDGE ST
-----------------------------------------------------
City | WEST HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-729-6138
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 78 CAMBRIDGE ST
-----------------------------------------------------
City | WEST HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06110-2305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-729-6138
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOTHERAPIST
-----------------------------------------------------
Name | MISS JENNY ALZATE
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 860-729-6138
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 001777
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------