Provider Demographics
NPI:1477309557
Name:MUJAGIC, ALISA (LPC)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:MUJAGIC
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 WEAVER ST
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-4300
Mailing Address - Country:US
Mailing Address - Phone:917-292-1946
Mailing Address - Fax:
Practice Address - Street 1:127 WEAVER ST
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-4300
Practice Address - Country:US
Practice Address - Phone:917-292-1946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46.007253101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor