Provider Demographics
NPI:1801433826
Name:MENSCHING, HOLLY DALE
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:DALE
Last Name:MENSCHING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-2813
Mailing Address - Country:US
Mailing Address - Phone:203-536-4642
Mailing Address - Fax:
Practice Address - Street 1:149 CHERRY ST
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-5525
Practice Address - Country:US
Practice Address - Phone:203-536-4642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002551101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health