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General NPI Number Information
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NPI Number | 1972093284
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Entity Type | Organization
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Legal Business Name | INSIGHT PSYCHOTHERAPY SERVICES, LLC
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Dates
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Enumeration Date | 05/11/2018
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Last Update Date | 05/11/2018
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Provider Practice Location Address
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Address Line | 61 BRADLEY ST
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City | BRISTOL
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State | CT
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Zip | 06010-5103
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Country | US
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Telephone | 860-470-6366
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Fax |
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Provider Business Mailing Address
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Address Line | 136 TUNXIS VLG
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City | FARMINGTON
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State | CT
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Zip | 06032-1502
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Country | US
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Telephone | 860-470-6366
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Fax |
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Authorized Official
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Title or Position | MARRIAGE AND FAMILY THERAPIST
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Name | ANGELA BURGESS
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Credential | MA., LMFT
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Telephone | 860-470-6366
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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 | 001978
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License Number State | CT
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