Provider Demographics
NPI:1508632027
Name:SMILEY, EBONEE MONIQUE (MFT-A)
Entity Type:Individual
Prefix:
First Name:EBONEE
Middle Name:MONIQUE
Last Name:SMILEY
Suffix:
Gender:F
Credentials:MFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 W MAIN ST STE 3-15
Mailing Address - Street 2:
Mailing Address - City:NIANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06357-2332
Mailing Address - Country:US
Mailing Address - Phone:860-451-9364
Mailing Address - Fax:
Practice Address - Street 1:8 W MAIN ST STE 3-15
Practice Address - Street 2:
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-2332
Practice Address - Country:US
Practice Address - Phone:203-249-3184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3304106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist