Provider Demographics
NPI:1568612372
Name:ANDRICOVICH, EILEEN G (LMFT)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:G
Last Name:ANDRICOVICH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 OLD NEW MILFORD ROAD
Mailing Address - Street 2:SUITE 1-B
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804
Mailing Address - Country:US
Mailing Address - Phone:203-775-2583
Mailing Address - Fax:206-775-2863
Practice Address - Street 1:2 OLD NEW MILFORD ROAD
Practice Address - Street 2:SUITE 1-B
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804
Practice Address - Country:US
Practice Address - Phone:203-775-2583
Practice Address - Fax:203-775-2863
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT-771106H00000X
CT#001720106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist