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NPI Code Detail

MEDICARE: GEORGETTE QUACKENBUSH HARRISON EDM, LPC, NCC

MEDICARE: GEORGETTE QUACKENBUSH HARRISON EDM, LPC, NCC
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
1101YP2500XProfessional Counselor001799CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154509909
Entity Type Code : Individual
Provider Name (Legal Business Name) : GEORGETTE QUACKENBUSH HARRISON EDM, LPC, NCC
Provider Business Mailing Address
First Line : 103 W BROAD ST
Second Line :
City : STAMFORD
State : CT
Zip : 06902-3713
Country : US
Telephone Number : 203-517-3376
Fax Number :
Provider Business Practice Location Address
First Line : 103 W BROAD ST
Second Line :
City : STAMFORD
State : CT
Zip : 06902-3713
Country : US
Telephone Number : 203-517-3376
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2008
Last Update Date : 04/26/2016

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