Organization
MARY ELLEN STAUDT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY ELLEN STAUDT LPC (OWNER)
(203) 554-4091
Entity
Organization
Contact information
Practice address
21 BRIDGE SQ, WESTPORT, CT 06880-5900
(203) 554-4091
(203) 368-9167
Mailing address
21 BRIDGE SQ, WESTPORT, CT 06880-5900
(203) 554-4091
(203) 368-9167
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
003152
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ANTHEM
ANTHEM NOT YET ISSUED
CT
Enumeration date
06/30/2017
Last updated
07/21/2022
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