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General NPI Number Information
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NPI Number | 1386144178
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Entity Type | Organization
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Legal Business Name | GLADYS' COUNSELING PLACE, PLLC-WHERE LIFE'S MOMENTS MAKE YOU STRONGER
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Dates
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Enumeration Date | 02/18/2018
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Last Update Date | 02/18/2018
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Provider Practice Location Address
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Address Line | 240 ORCHARD HILL DR
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-3025
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Country | US
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Telephone | 860-490-8384
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Fax |
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Provider Business Mailing Address
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Address Line | 240 ORCHARD HILL DR
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-3025
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Country | US
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Telephone | 860-490-8384
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MARIE A.C. CORTEZ
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Credential | LCSW
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Telephone | 860-490-8384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 009597
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License Number State | CT
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