Provider Demographics
NPI:1437625936
Name:PSYCHOTHERAPY PRACTICE OF VICTORIA HALL, LLC
Entity Type:Organization
Organization Name:PSYCHOTHERAPY PRACTICE OF VICTORIA HALL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-219-9954
Mailing Address - Street 1:31 CHERRY ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3465
Mailing Address - Country:US
Mailing Address - Phone:203-219-9954
Mailing Address - Fax:
Practice Address - Street 1:31 CHERRY ST STE 101
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3465
Practice Address - Country:US
Practice Address - Phone:203-219-9954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT13-6238845Medicaid