# REQUA PSYCHOTHERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124366745
- **Authorized official:** SARA S REQUA LMFT (OWNER/THERAPIST)
- **Authorized official phone:** (203) 803-0469

## Contact information

- **Practice address:** 72 PARK ST, SUITE 103, NEW CANAAN, CT 06840-4532
- **Practice address phone:** (203) 803-0469
- **Mailing address:** PO BOX 1007, SOUTHBURY, CT 06488-4107
- **Mailing address phone:** (203) 803-0469

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | 001415 | CT | Yes |

## Other

- **Enumeration date:** 01/17/2013
- **Last updated:** 01/17/2013