Provider Demographics
NPI:1053674127
Name:NORTH CENTRAL CONNECTICUT PSYCHOTHERAPY
Entity type:Organization
Organization Name:NORTH CENTRAL CONNECTICUT PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:CATHRYN
Authorized Official - Last Name:ALIENGENA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CAGS, LPC, MBA
Authorized Official - Phone:413-478-1764
Mailing Address - Street 1:PO BOX 574
Mailing Address - Street 2:
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-0574
Mailing Address - Country:US
Mailing Address - Phone:413-478-1764
Mailing Address - Fax:
Practice Address - Street 1:230B MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06078-2094
Practice Address - Country:US
Practice Address - Phone:413-478-1764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001395101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty