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General NPI Number Information
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NPI Number | 1801369970
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Entity Type | Organization
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Legal Business Name | AIMEE MUTH LCSW LLC
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Dates
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Enumeration Date | 01/10/2019
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Last Update Date | 01/10/2019
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Provider Practice Location Address
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Address Line | 3 W END AVE STE 2
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City | OLD GREENWICH
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State | CT
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Zip | 06870-1640
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Country | US
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Telephone | 203-554-7923
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 551
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City | RIVERSIDE
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State | CT
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Zip | 06878-0551
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Country | US
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Telephone | 203-554-7923
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | AIMEE MUTH
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Credential | LCSW
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Telephone | 203-554-7923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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