| Preservation Within Therapy Practice, Llc | |
|
134 Main St Putnam CT 06260-1920 | |
| (860) 926-0142 | |
| (860) 413-0919 |
| Full Name | Preservation Within Therapy Practice, Llc |
|---|---|
| Speciality | Counselor |
| Location | 134 Main St, Putnam, Connecticut |
| Authorized Official Name and Position | Amanda Jean Nowak (LICENSED PROFESSIONAL COUNSELOR) |
| Authorized Official Contact | 8609260142 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Preservation Within Therapy Practice, Llc Po Box 633 Putnam CT 06260-0633 Ph: (860) 926-0142 | Preservation Within Therapy Practice, Llc 134 Main St Putnam CT 06260-1920 Ph: (860) 926-0142 |
| NPI Number | 1891313797 |
|---|---|
| Provider Enumeration Date | 07/08/2020 |
| Last Update Date | 07/08/2020 |
| Certification Date | 07/08/2020 |
| Medicare PECOS PAC ID | 4082050091 |
|---|---|
| Medicare Enrollment ID | O20240313001677 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891313797 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Amanda Nowak |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1598178865 PECOS PAC ID: 5991141905 Enrollment ID: I20240313001808 |
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