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General NPI Number Information
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NPI Number | 1487163986
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Entity Type | Individual
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Provider Name | EMILY WALLER LMHC-LPC
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Gender | Female
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Dates
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Enumeration Date | 09/27/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 101 GROVE ST
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City | STAMFORD
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State | CT
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Zip | 06901-1844
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Country | US
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Telephone | 917-880-0292
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Fax |
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Provider Business Mailing Address
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Address Line | 562 HOPE ST
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City | STAMFORD
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State | CT
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Zip | 06907-2722
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Country | US
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Telephone | 914-361-5037
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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 | 009516-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 004951
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License Number State | CT
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