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General NPI Number Information
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NPI Number | 1891716627
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Entity Type | Organization
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Legal Business Name | LAUREL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 11/28/2011
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Provider Practice Location Address
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Address Line | 295 WASHINGTON AVE SUITE 9
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City | HAMDEN
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State | CT
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Zip | 06518-3025
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Country | US
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Telephone | 203-287-8227
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Fax | 203-287-9502
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Provider Business Mailing Address
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Address Line | 295 WASHINGTON AVE SUITE 9
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City | HAMDEN
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State | CT
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Zip | 06518-3025
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Country | US
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Telephone | 203-287-8227
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Fax | 203-287-9502
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Authorized Official
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Title or Position | PARTNER
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Name | DR. JEFFREY WARREN SUMMERVILLE
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Credential | PSY.D., LCSW
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Telephone | 203-287-8227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 589570
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License Number State | CT
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