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General NPI Number Information
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NPI Number | 1487194213
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Entity Type | Organization
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Legal Business Name | MARIETTA WHITTLESEY LPC LLC
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Dates
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Enumeration Date | 02/27/2017
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Last Update Date | 02/27/2017
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Provider Practice Location Address
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Address Line | 184 MAIN ST
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City | LAKEVILLE
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State | CT
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Zip | 06039-1100
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Country | US
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Telephone | 860-435-2777
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Fax | 860-435-2777
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Provider Business Mailing Address
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Address Line | PO BOX 125
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City | ANCRAMDALE
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State | NY
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Zip | 12503-0125
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Country | US
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Telephone | 860-435-2777
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Fax | 860-435-2777
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MARIETTA H WHITTLESEY
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Credential | LPC
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Telephone | 860-435-2777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2678
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License Number State | CT
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