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General NPI Number Information
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NPI Number | 1396870473
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Entity Type | Individual
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Provider Name | MS. ELLEN C GOLDEN
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Gender | Female
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 27 HARTFORD TPKE SUITE 204
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City | VERNON
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State | CT
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Zip | 06066-5245
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Country | US
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Telephone | 860-647-1875
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Fax | 860-533-1070
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Provider Business Mailing Address
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Address Line | 19 TIFFANY DR
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City | WINDSOR
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State | CT
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Zip | 06095-2471
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Country | US
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Telephone | 860-688-8027
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 004577
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License Number State | CT
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