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General NPI Number Information
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NPI Number | 1497142756
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Entity Type | Organization
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Legal Business Name | JOLANTA MARYANSKA THERAPY, LLC
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Dates
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Enumeration Date | 04/23/2015
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Last Update Date | 04/23/2015
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Provider Practice Location Address
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Address Line | 66 N MAIN ST
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City | BRANFORD
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State | CT
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Zip | 06405-3032
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Country | US
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Telephone | 203-376-3639
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Fax |
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Provider Business Mailing Address
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Address Line | 30 BARKER HILL DR
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City | GUILFORD
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State | CT
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Zip | 06437-2351
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Country | US
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Telephone | 203-376-3639
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JOLANTA MARYANSKA
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Credential | LMFT
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Telephone | 203-376-3639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 001692
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License Number State | CT
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