# WILLOW TREE PSYCHOTHERAPY

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

## Provider details

- **NPI number:** 1134988579
- **Authorized official:** ADELA BAJRAKTAREVIC (OWNER)
- **Authorized official phone:** (203) 558-8214

## Contact information

- **Practice address:** 13 PINE ACRES DR, CANTON, CT 06019-2135
- **Practice address phone:** (203) 558-8214
- **Mailing address:** 13 PINE ACRES DR, CANTON, CT 06019-2135

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 03/18/2024
- **Last updated:** 03/18/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1427695089 | NPI | — |