Provider Demographics
NPI:1770947780
Name:PAOLO MORENA, LLC
Entity type:Organization
Organization Name:PAOLO MORENA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LPC
Authorized Official - Prefix:
Authorized Official - First Name:PAOLO
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:203-837-0055
Mailing Address - Street 1:109 DANBURY RD
Mailing Address - Street 2:SUITE D-2
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4142
Mailing Address - Country:US
Mailing Address - Phone:203-837-0055
Mailing Address - Fax:800-942-6201
Practice Address - Street 1:109 DANBURY RD
Practice Address - Street 2:SUITE D-2
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4142
Practice Address - Country:US
Practice Address - Phone:203-837-0055
Practice Address - Fax:800-942-6201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46.002852101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty