Provider Demographics
NPI:1114321239
Name:OLIVER TAEB LLC
Entity Type:Organization
Organization Name:OLIVER TAEB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:TAEB
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:860-618-5910
Mailing Address - Street 1:1 TORRINGTON OFFICE PLZ
Mailing Address - Street 2:301
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-3854
Mailing Address - Country:US
Mailing Address - Phone:860-618-5910
Mailing Address - Fax:831-618-5917
Practice Address - Street 1:1 TORRINGTON OFFICE PLZ
Practice Address - Street 2:301
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-3854
Practice Address - Country:US
Practice Address - Phone:860-618-5910
Practice Address - Fax:831-618-5917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1620261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center