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General NPI Number Information
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NPI Number | 1578704219
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Entity Type | Organization
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Legal Business Name | CENTRAL CONNECTICUT PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 03/10/2009
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Last Update Date | 03/10/2009
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Provider Practice Location Address
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Address Line | 23 LIBERTY DR SUITE 23 B-1
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City | HEBRON
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State | CT
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Zip | 06248
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Country | US
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Telephone | 860-337-7144
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Fax | 860-337-7155
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Provider Business Mailing Address
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Address Line | 23 LIBERTY DR SUITE B-1
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City | HEBRON
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State | CT
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Zip | 06248-1553
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Country | US
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Telephone | 860-337-7144
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Fax | 860-337-7155
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MS. MAUREEN PICKUP
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Credential | LCSW
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Telephone | 860-337-7144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 006447
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License Number State | CT
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