Provider Demographics
NPI: | 1952760803 |
---|---|
Name: | DARBONSHIRE, LLC |
Entity Type: | Organization |
Organization Name: | DARBONSHIRE, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | FAMILY THERAPIST |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | DARBY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | FOX |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LCSW |
Authorized Official - Phone: | 203-313-1662 |
Mailing Address - Street 1: | 304 WAHACKME RD |
Mailing Address - Street 2: | |
Mailing Address - City: | NEW CANAAN |
Mailing Address - State: | CT |
Mailing Address - Zip Code: | 06840-3936 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 203-313-1662 |
Mailing Address - Fax: | 203-966-8682 |
Practice Address - Street 1: | 304 WAHACKME RD |
Practice Address - Street 2: | |
Practice Address - City: | NEW CANAAN |
Practice Address - State: | CT |
Practice Address - Zip Code: | 06840-3936 |
Practice Address - Country: | US |
Practice Address - Phone: | 203-313-1662 |
Practice Address - Fax: | 203-966-8682 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-02-21 |
Last Update Date: | 2019-05-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CT | 002829 | 261QM0855X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |