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General NPI Number Information
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NPI Number | 1598311599
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Entity Type | Organization
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Legal Business Name | FAMILIES ON THE LINE, LLC
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Dates
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Enumeration Date | 08/15/2019
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Last Update Date | 08/15/2019
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Provider Practice Location Address
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Address Line | 129 CHURCH ST STE 807
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City | NEW HAVEN
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State | CT
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Zip | 06510-2005
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Country | US
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Telephone | 203-981-0113
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Fax |
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Provider Business Mailing Address
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Address Line | 779 HIGH ST
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City | FAIRFIELD
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State | CT
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Zip | 06824-4015
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Country | US
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Telephone | 203-981-0113
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MS. MARIE-PAULE LOPEZ DE VALDIVIA
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Credential | LCSW
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Telephone | 203-981-0113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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