=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700905692
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIVER VALLEY COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 576 RUBBER AVE
-----------------------------------------------------
City | NAUGATUCK
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06770-3731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-723-4955
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 576 RUBBER AVE
-----------------------------------------------------
City | NAUGATUCK
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06770-3731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | MARGARET MCCORMACK
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 203-723-4955
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 000722
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------