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General NPI Number Information
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NPI Number | 1942194170
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Entity Type | Individual
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Provider Name | MRS. IVY MARIYAM THOMAS
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Gender | Female
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Dates
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Enumeration Date | 06/03/2025
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 900 MAIN ST S STE 201
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City | SOUTHBURY
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State | CT
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Zip | 06488-2224
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Country | US
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Telephone | 203-255-5078
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Fax |
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Provider Business Mailing Address
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Address Line | 9 WALNUT RIDGE RD
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City | NEW FAIRFIELD
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State | CT
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Zip | 06812-3214
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Country | US
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Telephone | 475-296-8690
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6939
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License Number State | CT
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