MEDICARE: MS. TIA SHARMAINE RHINEHART LADC, LPC

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	001095	CT
2	101YP2500X	Professional Counselor	4351	CT

General Provider Information

NPI Number	:	1205200672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TIA SHARMAINE RHINEHART LADC, LPC

Provider Business Mailing Address
First Line	:	48 SHEPARDS KNOLL DR
Second Line	:
City	:	HAMDEN
State	:	CT
Zip	:	06514-1805
Country	:	US
Telephone Number	:	203-558-6306
Fax Number	:	203-841-1054

Provider Business Practice Location Address
First Line	:	100 GRAND ST STE 2G
Second Line	:
City	:	WATERBURY
State	:	CT
Zip	:	06702-1908
Country	:	US
Telephone Number	:	203-527-0312
Fax Number	:	203-841-1054

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2015
Last Update Date	:	04/02/2024

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