| Mary Ellen Staudt, Llc | |
|
21 Bridge Sq Westport CT 06880-5900 | |
| (203) 554-4091 | |
| (203) 368-9167 |
| Full Name | Mary Ellen Staudt, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 21 Bridge Sq, Westport, Connecticut |
| Authorized Official Name and Position | Mary Ellen Staudt (OWNER) |
| Authorized Official Contact | 2035544091 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Ellen Staudt, Llc 21 Bridge Sq Westport CT 06880-5900 Ph: (203) 554-4091 | Mary Ellen Staudt, Llc 21 Bridge Sq Westport CT 06880-5900 Ph: (203) 554-4091 |
| NPI Number | 1245751155 |
|---|---|
| Provider Enumeration Date | 06/30/2017 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245751155 | NPI | - | NPPES |
| ANTHEM | Other | CT | ANTHEM NOT YET ISSUED |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 003152 (Connecticut) | Primary |
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