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General NPI Number Information
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NPI Number | 1720785868
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Entity Type | Organization
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Legal Business Name | ALAINA BROKAW, LPC, LLC
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Dates
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Enumeration Date | 02/09/2023
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 49 TOLLAND TURNPIKE #203F
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City | MANCHESTER
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State | CT
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Zip | 06042
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Country | US
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Telephone | 860-222-7073
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Fax | 860-215-4180
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Provider Business Mailing Address
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Address Line | 89 FINLEY ST
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City | MANCHESTER
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State | CT
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Zip | 06040-5615
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Country | US
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Telephone | 860-859-7949
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALAINA BROKAW
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Credential | LPC
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Telephone | 860-859-7949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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