Provider Demographics
NPI:1811444771
Name:RENEE EDDY LPC, LLC
Entity type:Organization
Organization Name:RENEE EDDY LPC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDDY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-889-0097
Mailing Address - Street 1:119 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2708
Mailing Address - Country:US
Mailing Address - Phone:860-889-0097
Mailing Address - Fax:860-889-3184
Practice Address - Street 1:119 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2708
Practice Address - Country:US
Practice Address - Phone:860-889-0097
Practice Address - Fax:860-889-3184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002152101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty