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General NPI Number Information
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NPI Number | 1669823191
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Entity Type | Organization
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Legal Business Name | ART THERAPY OF HAMDEN LLC
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Dates
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Enumeration Date | 06/27/2016
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Last Update Date | 09/26/2016
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Provider Practice Location Address
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Address Line | 2061 WHITNEY AVE
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City | NORTH HAVEN
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State | CT
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Zip | 06473-4474
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Country | US
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Telephone | 203-285-3053
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Fax | 203-907-4132
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Provider Business Mailing Address
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Address Line | 2061 WHITNEY AVE
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City | NORTH HAVEN
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State | CT
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Zip | 06473-4474
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Country | US
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Telephone | 203-285-3053
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Fax | 203-907-4132
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARGARET JOSEPHINE MCGOVERN
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Credential | LPC
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Telephone | 203-285-3053
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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 | 001399
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License Number State | CT
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