Provider Demographics
NPI:1356749667
Name:STABLE GROUNDS LLC
Entity type:Organization
Organization Name:STABLE GROUNDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:203-747-8734
Mailing Address - Street 1:21 HAZEL TER
Mailing Address - Street 2:SUITE B
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2209
Mailing Address - Country:US
Mailing Address - Phone:203-747-8734
Mailing Address - Fax:
Practice Address - Street 1:21 HAZEL TER
Practice Address - Street 2:SUITE B
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2209
Practice Address - Country:US
Practice Address - Phone:203-747-8734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003383103TB0200X
CT003385103TC0700X, 103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty