# LISA SHOGLOW, LLC

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

## Provider details

- **NPI number:** 1366908550
- **Authorized official:** GRACE CULLEN (MEDICAL BILLING MANAGER)
- **Authorized official phone:** (203) 368-5515

## Contact information

- **Practice address:** 64 OLD HYDE RD, WESTON, CT 06883-1726
- **Practice address phone:** (203) 810-8348
- **Mailing address:** 64 OLD HYDE RD, WESTON, CT 06883-1726
- **Mailing address phone:** (203) 810-8348

## Taxonomy

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

## Other

- **Enumeration date:** 02/13/2019
- **Last updated:** 02/13/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 004069985 | — | CT |