Provider Demographics
NPI:1326797234
Name:SIDHU, RIYA KAUR (LPC)
Entity Type:Individual
Prefix:
First Name:RIYA
Middle Name:KAUR
Last Name:SIDHU
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-2315
Mailing Address - Country:US
Mailing Address - Phone:203-512-1692
Mailing Address - Fax:
Practice Address - Street 1:85 KNOLLWOOD DR
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-2315
Practice Address - Country:US
Practice Address - Phone:203-512-1692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-20
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005426101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional