| Single Person Llc | |
|
3300 Main St Stratford CT 06614 | |
| (203) 378-4514 | |
| (203) 378-0443 |
| Full Name | Single Person Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3300 Main St, Stratford, Connecticut |
| Authorized Official Name and Position | Kathleen E Myers (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2033784514 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Single Person Llc 3300 Main St Stratford CT 06614 Ph: (203) 378-4514 | Single Person Llc 3300 Main St Stratford CT 06614 Ph: (203) 378-4514 |
| NPI Number | 1598844714 |
|---|---|
| Provider Enumeration Date | 11/06/2006 |
| Last Update Date | 06/26/2024 |
| Certification Date | 06/26/2024 |
| Medicare PECOS PAC ID | 0648450072 |
|---|---|
| Medicare Enrollment ID | O20110202000292 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598844714 | NPI | - | NPPES |
| 004125961 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | C-0209 (Connecticut) | Primary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | 0309 (Connecticut) | Secondary |
| Provider Name | Kathleen E Myers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740226786 PECOS PAC ID: 3375573876 Enrollment ID: I20220311001094 |
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