Provider Demographics
| NPI: | 1811712482 |
|---|---|
| Name: | NOROTON PRESBYTERIAN CHURCH |
| Entity type: | Organization |
| Organization Name: | NOROTON PRESBYTERIAN CHURCH |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CLINICAL DIRECTOR |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | JEFFREY |
| Authorized Official - Middle Name: | WHEELER |
| Authorized Official - Last Name: | WHITE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | PHD, LMFT |
| Authorized Official - Phone: | 203-309-5610 |
| Mailing Address - Street 1: | 50 OLD KINGS HWY N FL 2 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | DARIEN |
| Mailing Address - State: | CT |
| Mailing Address - Zip Code: | 06820-4637 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 203-998-8121 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 50 OLD KINGS HWY N FL 2 |
| Practice Address - Street 2: | |
| Practice Address - City: | DARIEN |
| Practice Address - State: | CT |
| Practice Address - Zip Code: | 06820-4637 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 203-309-5310 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | NOROTON PRESBYTERIAN CHURCH |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2024-11-19 |
| Last Update Date: | 2024-11-19 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
| No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | Group - Multi-Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
