Provider Demographics
NPI:1801287628
Name:PSYCHOTHERAPY AT HOME, LLC
Entity type:Organization
Organization Name:PSYCHOTHERAPY AT HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVINO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-982-3551
Mailing Address - Street 1:16 RAIN DANCE CIR
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-4834
Mailing Address - Country:US
Mailing Address - Phone:203-982-3551
Mailing Address - Fax:
Practice Address - Street 1:16 RAIN DANCE CIR
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4834
Practice Address - Country:US
Practice Address - Phone:203-982-3551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007456251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health