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100 Danbury Rd Ste 203b Ridgefield CT 06877-4122 | |
| (203) 240-7093 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 100 Danbury Rd Ste 203b, Ridgefield, Connecticut |
| Authorized Official Name and Position | Bonnie Luft (CEO/OWNER) |
| Authorized Official Contact | 0324070932 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
100b Danbury Road Ste 203b Ridgefield CT 06877 Ph: () - | 100 Danbury Rd Ste 203b Ridgefield CT 06877-4122 Ph: (203) 240-7093 |
| NPI Number | 1518729326 |
|---|---|
| Provider Enumeration Date | 01/26/2024 |
| Last Update Date | 10/15/2024 |
| Certification Date | 10/15/2024 |
| Medicare PECOS PAC ID | 4587197272 |
|---|---|
| Medicare Enrollment ID | O20241104000105 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518729326 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
| Provider Name | Yvonne Mora |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1316562622 PECOS PAC ID: 6305381708 Enrollment ID: I20240710001242 |
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