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NPI 1629319025

NPI 1629319025 : CHERYL BALL LMFT : MONROE, CT

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General NPI Number Information
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    NPI Number           |    1629319025
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    Entity Type          |    Individual 
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    Provider Name        |    CHERYL BALL LMFT
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    03/09/2013
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    Last Update Date     |    06/01/2015
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Provider Practice Location Address
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    Address Line         |    755 MAIN ST BLDG 2, SUITE 1
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    City                 |    MONROE
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    State                |    CT
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    Zip                  |    06468-2830
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    Country              |    US
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    Telephone            |    203-383-9872
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    323 WEBB CIR 
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    City                 |    MONROE
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    State                |    CT
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    Zip                  |    06468-1453
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    Country              |    US
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    Telephone            |    203-383-9872
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    Fax                  |    
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    106H00000X
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    Taxonomy Name        |    Marriage & Family Therapist
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    License Number       |    1500
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    License Number State |    CT
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