Provider Demographics
NPI:1801369970
Name:AIMEE MUTH LCSW LLC
Entity Type:Organization
Organization Name:AIMEE MUTH LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-554-7923
Mailing Address - Street 1:PO BOX 551
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CT
Mailing Address - Zip Code:06878-0551
Mailing Address - Country:US
Mailing Address - Phone:203-554-7923
Mailing Address - Fax:
Practice Address - Street 1:3 W END AVE STE 2
Practice Address - Street 2:
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-1640
Practice Address - Country:US
Practice Address - Phone:203-554-7923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)