Provider Demographics
NPI:1629640198
Name:PHENOMENAL WOMAN COUNSELING
Entity Type:Organization
Organization Name:PHENOMENAL WOMAN COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDER-FOX
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-243-1378
Mailing Address - Street 1:137 MARSH WAY
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-2953
Mailing Address - Country:US
Mailing Address - Phone:203-243-1377
Mailing Address - Fax:
Practice Address - Street 1:1000 LAFAYETTE BLVD STE 1100
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-4710
Practice Address - Country:US
Practice Address - Phone:203-243-1377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)