=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811437536
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACCESSIBLE MENTAL HEALTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2017
-----------------------------------------------------
Last Update Date | 03/10/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 639 PROSPECT AVE 3RD FLOOR
-----------------------------------------------------
City | WEST HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06105-4276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-539-5430
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 639 PROSPECT AVE 3RD FLOOR
-----------------------------------------------------
City | WEST HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06105-4276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-539-5430
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST, CLINICIAN
-----------------------------------------------------
Name | MISS JACQUELINE B. LEVIN
-----------------------------------------------------
Credential | LMFT, MS, MA,BFA
-----------------------------------------------------
Telephone | 860-385-1574
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------