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General NPI Number Information
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NPI Number | 1831652064
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Entity Type | Organization
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Legal Business Name | SEAGULL COUNSELING & THERAPY LLC
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Dates
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Enumeration Date | 04/14/2019
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Last Update Date | 04/14/2019
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Provider Practice Location Address
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Address Line | 35 NUTMEG LANE
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City | FAIRFIELD
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State | CT
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Zip | 06824
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Country | US
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Telephone | 203-993-5831
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Fax | 203-259-3338
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Provider Business Mailing Address
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Address Line | 35 NUTMEG LN
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City | FAIRFIELD
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State | CT
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Zip | 06824-3909
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Country | US
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Telephone | 203-993-5831
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Fax | 203-259-3338
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Authorized Official
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Title or Position | OWNER/CLINICAL SOCIAL WORKER
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Name | MRS. SUSAN L HENRY
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Credential | LCSW
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Telephone | 203-258-8627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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