Provider Demographics
NPI:1679279673
Name:SOL PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:SOL PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:MISS
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:S
Authorized Official - Last Name:PASTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-570-2702
Mailing Address - Street 1:44 FERRIS AVE APT 1C
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-1571
Mailing Address - Country:US
Mailing Address - Phone:203-570-2702
Mailing Address - Fax:
Practice Address - Street 1:44 FERRIS AVE APT 1C
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-1571
Practice Address - Country:US
Practice Address - Phone:203-570-2702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1487131538Medicaid