| Revision Studio Llc Therapy And Counseling Services | |
|
3 West End Avenue Old Greenwich CT 06870-9203 | |
| (203) 274-4284 | |
| Not Available |
| Full Name | Revision Studio Llc Therapy And Counseling Services |
|---|---|
| Speciality | Social Worker |
| Location | 3 West End Avenue, Old Greenwich, Connecticut |
| Authorized Official Name and Position | Judith Deborah Croen (OWNER) |
| Authorized Official Contact | 2032744284 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revision Studio Llc Therapy And Counseling Services P.o. Box 172 Old Greenwich CT 06870-9203 Ph: (203) 274-4284 | Revision Studio Llc Therapy And Counseling Services 3 West End Avenue Old Greenwich CT 06870-9203 Ph: (203) 274-4284 |
| NPI Number | 1841639556 |
|---|---|
| Provider Enumeration Date | 06/17/2013 |
| Last Update Date | 01/21/2015 |
| Medicare PECOS PAC ID | 5698089217 |
|---|---|
| Medicare Enrollment ID | O20150727002052 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841639556 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 004269 (Connecticut) | Primary |
| Provider Name | Judith D Croen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184712176 PECOS PAC ID: 5496780546 Enrollment ID: I20050928000455 |
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