Provider Demographics
NPI:1669823191
Name:ART THERAPY OF HAMDEN LLC
Entity type:Organization
Organization Name:ART THERAPY OF HAMDEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:JOSEPHINE
Authorized Official - Last Name:MCGOVERN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-285-3053
Mailing Address - Street 1:2061 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-4474
Mailing Address - Country:US
Mailing Address - Phone:203-285-3053
Mailing Address - Fax:203-907-4132
Practice Address - Street 1:2061 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-4474
Practice Address - Country:US
Practice Address - Phone:203-285-3053
Practice Address - Fax:203-907-4132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001399101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004272332Medicaid