Provider Demographics
NPI:1124101696
Name:THE MOTIVATION CENTER OF STRATFORD, INC.
Entity type:Organization
Organization Name:THE MOTIVATION CENTER OF STRATFORD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MARGOLIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-929-2093
Mailing Address - Street 1:110 SOUNDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484
Mailing Address - Country:US
Mailing Address - Phone:203-929-2093
Mailing Address - Fax:203-929-2093
Practice Address - Street 1:110 SOUNDVIEW AVE
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484
Practice Address - Country:US
Practice Address - Phone:203-929-2093
Practice Address - Fax:203-929-2093
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MOTIVATION CENTER OF STRATFORD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-20
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT001255103T00000X
CT001255103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT5004086840Medicaid
CT=========OtherTAX ID #