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General NPI Number Information
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NPI Number | 1699930370
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Entity Type | Organization
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Legal Business Name | INDIVIDUAL AND FAMILY COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 07/22/2008
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Last Update Date | 02/16/2009
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Provider Practice Location Address
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Address Line | 200 SILVER STREET 106
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City | AGAWAM
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State | MA
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Zip | 01001-1647
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Country | US
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Telephone | 413-789-9198
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Fax | 413-789-6322
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Provider Business Mailing Address
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Address Line | 200 SILVER STREET 106
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City | AGAWAM
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State | MA
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Zip | 01001-1647
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Country | US
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Telephone | 413-789-9198
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Fax | 413-789-6322
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Authorized Official
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Title or Position | SOCIAL WORKER/OWNER
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Name | MRS. CRISTINA DI NARDO-DUPRE
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Credential | LICSW
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Telephone | 413-789-9198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 106947
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License Number State | MA
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