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General NPI Number Information
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NPI Number | 1962965103
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Entity Type | Organization
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Legal Business Name | CKRCOUNSELING, LLC
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Dates
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Enumeration Date | 04/12/2019
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Last Update Date | 04/12/2019
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Provider Practice Location Address
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Address Line | 649 AMITY RD UNIT 103
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City | BETHANY
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State | CT
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Zip | 06524-3091
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Country | US
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Telephone | 475-227-9014
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Fax |
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Provider Business Mailing Address
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Address Line | 85 SORGHUM MILL DR
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City | CHESHIRE
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State | CT
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Zip | 06410-3052
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Country | US
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Telephone | 474-227-9014
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Fax |
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Authorized Official
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Title or Position | OWNER, SOLE MEMBER
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Name | CYBIL RYAN
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Credential | LCSW
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Telephone | 475-227-9014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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