Provider Demographics
NPI:1902498918
Name:NORTHEAST COUPLE AND FAMILY THERAPY LLC
Entity Type:Organization
Organization Name:NORTHEAST COUPLE AND FAMILY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:860-497-0024
Mailing Address - Street 1:16 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH GROSVENORDALE
Mailing Address - State:CT
Mailing Address - Zip Code:06255-1251
Mailing Address - Country:US
Mailing Address - Phone:401-290-7216
Mailing Address - Fax:
Practice Address - Street 1:39 1/2 WEDGEWOOD DR STE 1023
Practice Address - Street 2:
Practice Address - City:JEWETT CITY
Practice Address - State:CT
Practice Address - Zip Code:06351-2439
Practice Address - Country:US
Practice Address - Phone:860-497-0024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty