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General NPI Number Information
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NPI Number | 1710748850
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Entity Type | Organization
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Legal Business Name | PSYCHOTHERAPY CENTER FOR GRIEF AND HOSPICE COUNSELING, LLC
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Dates
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Enumeration Date | 01/16/2024
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Last Update Date | 02/01/2024
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Provider Practice Location Address
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Address Line | 151 NEW PARK AVE STE 120
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City | HARTFORD
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State | CT
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Zip | 06106-2174
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Country | US
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Telephone | 973-873-3933
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Fax |
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Provider Business Mailing Address
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Address Line | 16 PROSPECT ST
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City | BLOOMFIELD
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State | CT
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Zip | 06002-3016
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Country | US
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Telephone | 973-873-3933
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | BIDOSSESSI(BIDO) E AGUESSY
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Credential | PSYD
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Telephone | 973-873-3933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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