Organization
TERAPIA DE JUEGO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LOUISE MADELYN TONNING LCSW (LICENSED CLINICAL SOCIAL WORKER)
(203) 883-8135
Entity
Organization
Contact information
Practice address
30 MYANO LN, SUITE 20, STAMFORD, CT 06902-4532
(220) 388-3813
(203) 883-8139
Mailing address
30 MYANO LN, SUITE 20, STAMFORD, CT 06902-4532
(220) 388-3813
(203) 883-8139
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
001536
CT
251S00000X
Community/Behavioral Health Agency
R071645
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008017104
—
CT
Enumeration date
02/26/2016
Last updated
02/26/2016
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