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General NPI Number Information
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NPI Number | 1407254873
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Entity Type | Organization
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Legal Business Name | APPLIED THERAPEUTIC SUPPORT, LLC
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Dates
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Enumeration Date | 12/16/2014
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Last Update Date | 12/16/2014
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Provider Practice Location Address
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Address Line | 310 MAIN ST LOWER LEVEL
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City | EAST HAVEN
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State | CT
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Zip | 06512-2919
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Country | US
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Telephone | 203-444-7778
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Fax | 203-404-7126
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Provider Business Mailing Address
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Address Line | 92 LIMEWOOD AVE #B12
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City | BRANFORD
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State | CT
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Zip | 06405-5340
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Country | US
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Telephone | 203-444-7778
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Fax | 203-404-7126
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Authorized Official
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Title or Position | OWNER
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Name | ELIZABETH M SHEA
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Credential | LCSW
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Telephone | 203-444-7778
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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 | 008767
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License Number State | CT
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