Individual
PHOUANGMALY PHIMVONGSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.P.C
Contact information
Practice address
82 MAIN ST, WINDSOR LOCKS, CT 06096-2325
(860) 254-5127
(860) 310-4235
Mailing address
82 MAIN ST, WINDSOR LOCKS, CT 06096-2325
(860) 254-5127
(860) 310-4235
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
001470
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004257053
—
CT
Enumeration date
12/05/2006
Last updated
12/19/2019
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