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General NPI Number Information
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NPI Number | 1760709802
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Entity Type | Organization
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Legal Business Name | AMITY COUNSELING AND ATTACHMENT CENTER, LLC
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Dates
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Enumeration Date | 04/29/2010
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Last Update Date | 04/29/2010
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Provider Practice Location Address
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Address Line | 214 AMITY RD SUITE C
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City | WOODBRIDGE
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State | CT
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Zip | 06525-2241
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Country | US
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Telephone | 203-230-0886
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Fax |
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Provider Business Mailing Address
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Address Line | 20 HOMESTEAD AVE
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City | HAMDEN
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State | CT
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Zip | 06514-3505
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Country | US
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Telephone | 203-230-0886
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. DIANE SWIFT
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Credential | LPC
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Telephone | 203-230-0886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 001848
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License Number State | CT
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