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General NPI Number Information
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NPI Number | 1982237053
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Entity Type | Organization
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Legal Business Name | ALEXANDRA CORRIVEAU LLC
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Dates
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Enumeration Date | 02/18/2020
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Last Update Date | 02/18/2020
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Provider Practice Location Address
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Address Line | 387C TUCKIE RD
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City | NORTH WINDHAM
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State | CT
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Zip | 06256-1370
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Country | US
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Telephone | 860-576-8236
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Fax | 860-786-7932
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Provider Business Mailing Address
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Address Line | 55 E BROWN ST
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City | WEST HAVEN
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State | CT
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Zip | 06516-5130
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Country | US
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Telephone | 860-576-8236
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Fax | 860-786-7932
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Authorized Official
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Title or Position | LPC
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Name | ALEXANDRA CORRIVEAU
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Credential |
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Telephone | 860-576-8236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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