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General NPI Number Information
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NPI Number | 1497049233
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Entity Type | Organization
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Legal Business Name | ART FOR THERAPY
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Dates
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Enumeration Date | 06/08/2011
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Last Update Date | 06/08/2011
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Provider Practice Location Address
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Address Line | 19 RAYMOND HTS
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City | DARIEN
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State | CT
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Zip | 06820-4920
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Country | US
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Telephone | 203-722-4141
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Fax |
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Provider Business Mailing Address
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Address Line | 19 RAYMOND HTS
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City | DARIEN
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State | CT
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Zip | 06820-4920
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Country | US
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Telephone | 203-722-4141
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARY PELLICCI HAMILTON
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Credential | MSAT, ATR, LPC
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Telephone | 203-722-4141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 001779
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License Number State | CT
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