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General NPI Number Information
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NPI Number | 1639570690
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Entity Type | Organization
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Legal Business Name | CAROL MADDEN WINSLOW
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Dates
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Enumeration Date | 09/09/2014
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Last Update Date | 09/09/2014
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Provider Practice Location Address
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Address Line | 18 MYROCK AVE
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City | WATERFORD
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State | CT
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Zip | 06385-3008
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Country | US
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Telephone | 860-287-7203
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Fax |
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Provider Business Mailing Address
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Address Line | 83 BOSTON POST RD
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City | WATERFORD
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State | CT
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Zip | 06385-2423
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Country | US
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Telephone | 860-287-7203
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. CAROL MADDEN WINSLOW
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Credential | LMFT, LADC
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Telephone | 860-287-7203
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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 | 000676
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 000838
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License Number State | CT
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