=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528631348
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | E AND P THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2021
-----------------------------------------------------
Last Update Date | 07/20/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23B LIBERTY DR
-----------------------------------------------------
City | HEBRON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06248-1553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-531-2180
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 234
-----------------------------------------------------
City | HEBRON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06248-0234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-531-2180
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LPC
-----------------------------------------------------
Name | EMILY SCIGLIMPAGLIA-VIGUE
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 860-634-4277
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------