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General NPI Number Information
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NPI Number | 1649010034
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Entity Type | Organization
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Legal Business Name | OPTIMAL OUTCOMES THERAPY PLLC
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Dates
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Enumeration Date | 05/31/2024
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 36 LAKE DR S
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City | RIVERSIDE
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State | CT
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Zip | 06878-2024
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Country | US
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Telephone | 312-405-0140
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Fax |
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Provider Business Mailing Address
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Address Line | 36 LAKE DR S
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City | RIVERSIDE
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State | CT
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Zip | 06878-2024
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Country | US
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Telephone | 312-405-0140
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Fax |
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Authorized Official
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Title or Position | AGENT
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Name | ASHLEY PROGANO
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Credential |
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Telephone | 203-969-4654
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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 |
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License Number State |
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