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General NPI Number Information
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NPI Number | 1790425387
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Entity Type | Organization
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Legal Business Name | COMPASSIONATE COUNSELING AND CULINARY ARTS THERAPY LLC
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Dates
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Enumeration Date | 03/31/2022
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Last Update Date | 10/31/2022
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Provider Practice Location Address
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Address Line | 15 CASSWAY RD
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City | WOODBRIDGE
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State | CT
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Zip | 06525-1214
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Country | US
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Telephone | 516-528-3831
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Fax |
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Provider Business Mailing Address
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Address Line | 15 CASSWAY RD
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City | WOODBRIDGE
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State | CT
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Zip | 06525-1214
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Country | US
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Telephone | 516-528-3831
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | STEPHANIE AUDRA JACOBSON
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Credential | LCSW, PHD
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Telephone | 516-528-3831
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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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