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General NPI Number Information
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NPI Number | 1558723395
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Entity Type | Organization
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Legal Business Name | KATHERINE GOODMAN COUNSELING LLC
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | 33 PRATT ST
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City | GLASTONBURY
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State | CT
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Zip | 06033-1014
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Country | US
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Telephone | 203-247-3996
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Fax |
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Provider Business Mailing Address
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Address Line | 345 BUCKLAND HILLS DR 12222
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City | MANCHESTER
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State | CT
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Zip | 06042-8704
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Country | US
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Telephone | 203-247-3996
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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. KATHERINE BREWER GOODMAN
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Credential | LPC
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Telephone | 203-247-3996
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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 | 002807
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License Number State | CT
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