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General NPI Number Information
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NPI Number | 1871013219
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Entity Type | Organization
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Legal Business Name | GROWTH THERAPY LLC
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Dates
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Enumeration Date | 06/27/2017
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Last Update Date | 02/12/2019
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Provider Practice Location Address
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Address Line | 755 MAIN ST.
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City | MONROE
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State | CT
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Zip | 06468
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Country | US
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Telephone | 203-707-1277
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Fax |
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Provider Business Mailing Address
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Address Line | 24 EDGEWOOD AVE.
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City | MILFORD
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State | CT
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Zip | 06460
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KRISTEN COCCHIA DEW
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Credential | LMFT
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Telephone | 203-707-1277
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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 | 01710
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License Number State | CT
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