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General NPI Number Information
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NPI Number | 1437437431
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Entity Type | Organization
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Legal Business Name | COURAGE TO GROW, LLC
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Dates
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Enumeration Date | 07/26/2011
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Last Update Date | 07/26/2011
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Provider Practice Location Address
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Address Line | 162 B EAST MAIN STREET COURAGE TO GROW, LLC
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City | CLINTON
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State | CT
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Zip | 06413
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Country | US
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Telephone | 860-664-3592
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Fax | 860-664-3906
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Provider Business Mailing Address
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Address Line | 162 B EAST MAIN STREET
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City | CLINTON
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State | CT
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Zip | 06413
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Country | US
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Telephone | 860-664-3592
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Fax | 860-664-3906
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN J ISAAC
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Credential | LCSW
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Telephone | 860-664-3592
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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 | 005911
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License Number State | CT
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