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General NPI Number Information
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NPI Number | 1558879338
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Entity Type | Organization
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Legal Business Name | LOTUS PSYCHOTHERAPY OF FAIRFIELD COUNTY, PLLC
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Dates
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Enumeration Date | 01/16/2018
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Last Update Date | 01/16/2018
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Provider Practice Location Address
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Address Line | 6 THORNDAL CIR
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City | DARIEN
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State | CT
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Zip | 06820-5415
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Country | US
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Telephone | 203-536-7005
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Fax |
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Provider Business Mailing Address
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Address Line | 6 THORNDAL CIR
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City | DARIEN
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State | CT
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Zip | 06820-5415
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Country | US
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Telephone | 203-536-7005
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MS. AMY GRIMALDI
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Credential | LCSW
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Telephone | 203-536-7005
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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 | 008763
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License Number State | CT
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