=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821425778
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEX AND LOVE THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2013
-----------------------------------------------------
Last Update Date | 10/07/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 998 FARMINGTON AVE SUITE 201
-----------------------------------------------------
City | WEST HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06107-2162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-952-9070
-----------------------------------------------------
Fax | 860-461-7761
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 998 FARMINGTON AVE SUITE 201
-----------------------------------------------------
City | WEST HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06107-2162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-952-9070
-----------------------------------------------------
Fax | 860-461-7761
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. WENDY HAGGERTY
-----------------------------------------------------
Credential | M.S.M.F.T.
-----------------------------------------------------
Telephone | 860-952-9070
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 001617
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------