Provider Demographics
NPI:1982249710
Name:LOTUS PSYCHOTHERAPY, TRAINING AND CONSULTING
Entity Type:Organization
Organization Name:LOTUS PSYCHOTHERAPY, TRAINING AND CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAYNETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-886-6706
Mailing Address - Street 1:63 E GATE LN
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-2231
Mailing Address - Country:US
Mailing Address - Phone:203-886-6706
Mailing Address - Fax:
Practice Address - Street 1:63 E GATE LN
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-2231
Practice Address - Country:US
Practice Address - Phone:203-886-6706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)