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General NPI Number Information
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NPI Number | 1922853175
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Entity Type | Organization
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Legal Business Name | MR. THERAPY GUY LLC
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 605 WASHINGTON AVE
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City | NORTH HAVEN
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State | CT
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Zip | 06473-1123
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Country | US
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Telephone | 203-843-4456
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Fax |
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Provider Business Mailing Address
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Address Line | 1204 MAIN ST # 228
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City | BRANFORD
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State | CT
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Zip | 06405-3787
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Country | US
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Telephone | 203-843-4456
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGING MEMBER
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Name | MR. MICHAEL D PETRAS II
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Credential | LMFT
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Telephone | 203-843-4456
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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 |
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License Number State |
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