Organization
LISA SHOGLOW, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE CULLEN (MEDICAL BILLING MANAGER)
(203) 368-5515
Entity
Organization
Contact information
Practice address
64 OLD HYDE RD, WESTON, CT 06883-1726
(203) 810-8348
Mailing address
64 OLD HYDE RD, WESTON, CT 06883-1726
(203) 810-8348
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004069985
—
CT
Enumeration date
02/13/2019
Last updated
02/13/2019
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