Provider Demographics
NPI:1225693369
Name:ADULT, CHILD AND FAMILY PSYCHOTHERAPY
Entity Type:Organization
Organization Name:ADULT, CHILD AND FAMILY PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMERIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACARI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:475-777-6301
Mailing Address - Street 1:3095 MAIN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4852
Mailing Address - Country:US
Mailing Address - Phone:475-777-6301
Mailing Address - Fax:800-566-1452
Practice Address - Street 1:3095 MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4852
Practice Address - Country:US
Practice Address - Phone:475-777-6301
Practice Address - Fax:800-566-1452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008068250Medicaid