Provider Demographics
NPI:1407254873
Name:APPLIED THERAPEUTIC SUPPORT, LLC
Entity Type:Organization
Organization Name:APPLIED THERAPEUTIC SUPPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-444-7778
Mailing Address - Street 1:92 LIMEWOOD AVE
Mailing Address - Street 2:#B12
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-5340
Mailing Address - Country:US
Mailing Address - Phone:203-444-7778
Mailing Address - Fax:203-404-7126
Practice Address - Street 1:310 MAIN ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-2919
Practice Address - Country:US
Practice Address - Phone:203-444-7778
Practice Address - Fax:203-404-7126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0087671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty