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General NPI Number Information
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NPI Number | 1770839391
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Entity Type | Organization
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Legal Business Name | PEACE OF MIND PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 08/01/2012
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Last Update Date | 08/01/2012
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Provider Practice Location Address
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Address Line | 447 GLENBROOK RD
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City | STAMFORD
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State | CT
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Zip | 06906-1820
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Country | US
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Telephone | 203-560-8068
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Fax |
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Provider Business Mailing Address
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Address Line | 65 GLENBROOK RD APT 11D
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City | STAMFORD
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State | CT
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Zip | 06902-2963
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST/ OWNER
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Name | MARY CORDEAU
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Credential | CAS, MA, LPC
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Telephone | 203-560-8068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 001974
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License Number State | CT
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