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General NPI Number Information
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NPI Number | 1326410275
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Entity Type | Organization
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Legal Business Name | LAURA GUTMAN LLC
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Dates
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Enumeration Date | 10/30/2015
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Last Update Date | 10/30/2015
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Provider Practice Location Address
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Address Line | 13 CACCAMO TRL
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City | WESTPORT
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State | CT
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Zip | 06880-2506
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Country | US
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Telephone | 203-858-9914
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Fax |
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Provider Business Mailing Address
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Address Line | 13 CACCAMO TRL
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City | WESTPORT
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State | CT
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Zip | 06880-2506
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Country | US
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Telephone | 203-858-9914
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. LAURA GUTMAN
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Credential | PSY.D.
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Telephone | 203-858-9914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283X00000X
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Taxonomy Name | Rehabilitation Hospital
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License Number | 002527
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License Number State | CT
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