Organization Name: | SUSAN CONSOLI |
NPI Number: | 1174817357 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SUSAN E. CONSOLI (OWNER) |
Mailing Address: | 823 Boston Post Rd Suite 4 Old Saybrook |
State: | CT US |
Postal Code: | 064752100 |
Phone Number: | 8605758810 |
Fax Number: | |
NPI Enumeration Date: | 06/05/2011 |
NPI Last Update Date: | 06/05/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 002036 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |