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General NPI Number Information
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NPI Number | 1851827760
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Entity Type | Organization
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Legal Business Name | UNDER THE JEWEL TREE LLC
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 79 E PUTNAM AVE STE. 14
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City | GREENWICH
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State | CT
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Zip | 06830-5644
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Country | US
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Telephone | 203-489-3711
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Fax |
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Provider Business Mailing Address
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Address Line | 11 TURNER LN
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City | WILTON
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State | CT
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Zip | 06897-2009
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Country | US
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Telephone | 203-489-3711
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | MACKENZIE JENNINGS
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Credential |
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Telephone | 617-454-4916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 001880
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License Number State | CT
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