Provider Demographics
NPI:1649631185
Name:GUY ORLY
Entity type:Organization
Organization Name:GUY ORLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:
Authorized Official - Last Name:ORLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-858-8589
Mailing Address - Street 1:4 TRANQUILITY LN
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-5032
Mailing Address - Country:US
Mailing Address - Phone:203-858-8589
Mailing Address - Fax:
Practice Address - Street 1:4 TRANQUILITY LN
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5032
Practice Address - Country:US
Practice Address - Phone:203-858-8589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-11
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1799106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004069985Medicaid