Provider Demographics
NPI:1912300963
Name:TAEB, ALI OLIVER (LMFT, LADC)
Entity Type:Individual
Prefix:PROF
First Name:ALI
Middle Name:OLIVER
Last Name:TAEB
Suffix:
Gender:M
Credentials:LMFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TORRINGTON OFFICE PLZ
Mailing Address - Street 2:301
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-3854
Mailing Address - Country:US
Mailing Address - Phone:860-618-5910
Mailing Address - Fax:
Practice Address - Street 1:1 TORRINGTON OFFICE PLZ
Practice Address - Street 2:301
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-3854
Practice Address - Country:US
Practice Address - Phone:860-618-5910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1620106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist