MEDICARE: STEPHANIE K HEIN LMFT

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	106H00000X	Marriage & Family Therapist	001516	CT

General Provider Information

NPI Number	:	1871837385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE K HEIN LMFT

Provider Business Mailing Address
First Line	:	755 MAIN STREET
Second Line	:	BUILDING 2, SUITE 1
City	:	MONROE
State	:	CT
Zip	:	06468
Country	:	US
Telephone Number	:	203-376-2088
Fax Number	:

Provider Business Practice Location Address
First Line	:	755 MAIN ST
Second Line	:	BUILDING 2, SUITE 1
City	:	MONROE
State	:	CT
Zip	:	06468-2830
Country	:	US
Telephone Number	:	203-376-2088
Fax Number	:

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

Provider Enumeration Date	:	11/21/2012
Last Update Date	:	11/21/2012

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