Provider Demographics
NPI:1336680156
Name:LIVE BY THE SUN FEEL BY THE MOON
Entity Type:Organization
Organization Name:LIVE BY THE SUN FEEL BY THE MOON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:860-716-5318
Mailing Address - Street 1:128 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2254
Mailing Address - Country:US
Mailing Address - Phone:860-716-5318
Mailing Address - Fax:860-231-8006
Practice Address - Street 1:128 GARDEN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2254
Practice Address - Country:US
Practice Address - Phone:860-716-5318
Practice Address - Fax:860-231-8006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003036101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty