Provider Demographics
NPI:1114127636
Name:THE FAMILY ROOM, LLC
Entity Type:Organization
Organization Name:THE FAMILY ROOM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-522-4554
Mailing Address - Street 1:1015 CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-1644
Mailing Address - Country:US
Mailing Address - Phone:203-522-4554
Mailing Address - Fax:203-413-1587
Practice Address - Street 1:31 CHERRY ST
Practice Address - Street 2:2ND FLOOR, FRONT
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3414
Practice Address - Country:US
Practice Address - Phone:203-522-4554
Practice Address - Fax:203-413-1587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001151106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty