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General NPI Number Information
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NPI Number | 1588156905
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Entity Type | Organization
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Legal Business Name | CENTER FOR THERAPEUTIC CHANGE, LLC
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Dates
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Enumeration Date | 06/01/2018
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Last Update Date | 06/01/2018
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Provider Practice Location Address
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Address Line | 16 RIVER ST
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City | NORWALK
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State | CT
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Zip | 06850-3444
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Country | US
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Telephone | 203-640-7261
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Fax |
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Provider Business Mailing Address
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Address Line | 16 RIVER ST
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City | NORWALK
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State | CT
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Zip | 06850-3444
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Country | US
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Telephone | 203-640-7261
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JAMES AMARANTE
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Credential |
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Telephone | 203-640-7261
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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 | 2976
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License Number State | CT
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