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General NPI Number Information
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NPI Number | 1437410800
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Entity Type | Organization
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Legal Business Name | PEGGY-SUE FORSTER, LLC
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Dates
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Enumeration Date | 06/01/2012
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Last Update Date | 06/01/2012
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Provider Practice Location Address
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Address Line | 2551 POST RD
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City | SOUTHPORT
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State | CT
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Zip | 06890-1217
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Country | US
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Telephone | 203-984-1126
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Fax | 860-567-2195
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Provider Business Mailing Address
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Address Line | 2537 POST RD
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City | SOUTHPORT
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State | CT
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Zip | 06890-1242
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Country | US
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Telephone | 203-984-1126
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Fax | 860-567-2195
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. PEGGY-SUE K. FORSTER
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Credential | L.M.F.T.
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Telephone | 203-984-1126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 001441
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License Number State | CT
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