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General NPI Number Information
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NPI Number | 1902505803
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Entity Type | Organization
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Legal Business Name | SILVERMINE THERAPY LLC
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Dates
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Enumeration Date | 02/28/2023
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Last Update Date | 02/28/2023
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Provider Practice Location Address
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Address Line | 107 DEVONWOOD LN
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City | NEW CANAAN
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State | CT
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Zip | 06840-3337
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Country | US
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Telephone | 203-331-5999
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Fax |
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Provider Business Mailing Address
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Address Line | 24 EAST AVE # 221
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City | NEW CANAAN
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State | CT
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Zip | 06840-5529
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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 | LICENSED MASTER OF SOCIAL WORK
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Name | KRISTIE WALLACE SMITH
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Credential | LMSW
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Telephone | 203-331-5999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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