Organization
FAMILIES ON THE LINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARIE-PAULE LOPEZ DE VALDIVIA LCSW (PROGRAM DIRECTOR)
(203) 981-0113
Entity
Organization
Contact information
Practice address
129 CHURCH ST STE 807, NEW HAVEN, CT 06510-2005
(203) 981-0113
Mailing address
779 HIGH ST, FAIRFIELD, CT 06824-4015
(203) 981-0113
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
08/15/2019
Last updated
08/15/2019
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