Individual
CLUNY GOMBAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
400 COLUMBUS AVE, NEW HAVEN, CT 06519-1233
(203) 503-3055
(203) 503-3066
Mailing address
PO BOX 7720, CREDENTIALING SPECIALIST, NEW HAVEN, CT 06519-0720
(203) 503-3174
(203) 503-3183
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
002911
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004069985
—
CT
05
—
004235918
—
CT
Enumeration date
03/02/2016
Last updated
05/05/2017
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