| Terapia De Juego, Llc | |
|
30 Myano Ln Suite 20 Stamford CT 06902-4532 | |
| (220) 388-3813 | |
| (203) 883-8139 |
| Full Name | Terapia De Juego, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 30 Myano Ln, Stamford, Connecticut |
| Authorized Official Name and Position | Louise Madelyn Tonning (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 2038838135 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Terapia De Juego, Llc 30 Myano Ln Suite 20 Stamford CT 06902-4532 Ph: (220) 388-3813 | Terapia De Juego, Llc 30 Myano Ln Suite 20 Stamford CT 06902-4532 Ph: (220) 388-3813 |
| NPI Number | 1457711954 |
|---|---|
| Provider Enumeration Date | 02/26/2016 |
| Last Update Date | 02/26/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457711954 | NPI | - | NPPES |
| 008017104 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 001536 (Connecticut) | Primary |
| 251S00000X | Community/behavioral Health | R071645 (New York) | Secondary |
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