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NPI Code Detail

MEDICARE: SHKRELI PSYCHOTHERAPY, LLC

MEDICARE: SHKRELI PSYCHOTHERAPY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1093241556
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHKRELI PSYCHOTHERAPY, LLC
Provider Business Mailing Address
First Line : 158 GREENWOOD AVE
Second Line :
City : BETHEL
State : CT
Zip : 06801-2530
Country : US
Telephone Number : 203-493-4354
Fax Number :
Provider Business Practice Location Address
First Line : 158 GREENWOOD AVE
Second Line :
City : BETHEL
State : CT
Zip : 06801-2530
Country : US
Telephone Number : 203-493-4354
Fax Number :
Authorized Official
Title or Position : LCSW
Name : MARIA E SHKRELI
Credential : LCSW
Telephone Number : 203-493-4354
Provider Enumeration Date : 05/03/2017
Last Update Date : 05/08/2017

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