Provider Demographics
NPI:1649010034
Name:OPTIMAL OUTCOMES THERAPY PLLC
Entity type:Organization
Organization Name:OPTIMAL OUTCOMES THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PROGANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-969-4654
Mailing Address - Street 1:36 LAKE DR S
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CT
Mailing Address - Zip Code:06878-2024
Mailing Address - Country:US
Mailing Address - Phone:312-405-0140
Mailing Address - Fax:
Practice Address - Street 1:36 LAKE DR S
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CT
Practice Address - Zip Code:06878-2024
Practice Address - Country:US
Practice Address - Phone:312-405-0140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty