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General NPI Number Information
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NPI Number | 1881965002
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Entity Type | Organization
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Legal Business Name | SIDWAY COUNSELING, LLC
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Dates
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Enumeration Date | 01/19/2012
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Last Update Date | 01/19/2012
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Provider Practice Location Address
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Address Line | 76 WESTBURY PARK RD SUITE 303E
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City | WATERTOWN
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State | CT
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Zip | 06795-2779
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Country | US
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Telephone | 203-525-2091
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Fax | 860-417-6099
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Provider Business Mailing Address
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Address Line | 76 WESTBURY PARK RD SUITE 303E
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City | WATERTOWN
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State | CT
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Zip | 06795-2779
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Country | US
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Telephone | 203-525-2091
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Fax | 860-417-6099
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Authorized Official
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Title or Position | OWNER
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Name | MS. SUSAN P SIDWAY
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Credential | MS, LMFT
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Telephone | 203-525-2091
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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 | 001484
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License Number State | CT
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