| Applied Therapeutic Support, Llc | |
|
310 Main St Lower Level East Haven CT 06512-2919 | |
| (203) 444-7778 | |
| (203) 404-7126 |
| Full Name | Applied Therapeutic Support, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 310 Main St, East Haven, Connecticut |
| Authorized Official Name and Position | Elizabeth M Shea (OWNER) |
| Authorized Official Contact | 2034447778 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Applied Therapeutic Support, Llc 92 Limewood Ave #b12 Branford CT 06405-5340 Ph: (203) 444-7778 | Applied Therapeutic Support, Llc 310 Main St Lower Level East Haven CT 06512-2919 Ph: (203) 444-7778 |
| NPI Number | 1407254873 |
|---|---|
| Provider Enumeration Date | 12/16/2014 |
| Last Update Date | 12/16/2014 |
| Medicare PECOS PAC ID | 2567780927 |
|---|---|
| Medicare Enrollment ID | O20150415000170 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407254873 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 008767 (Connecticut) | Primary |
| Provider Name | Elizabeth M Shea |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043617806 PECOS PAC ID: 8820316292 Enrollment ID: I20150415000250 |
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