Organization
ETHERAPY OF CONNECTICUT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN ANDREW ROGALA LCSW (OWNER & PROVIDER)
(203) 308-8739
Entity
Organization
Contact information
Practice address
1062 BARNES RD STE 106, WALLINGFORD, CT 06492-6012
(860) 882-3268
(203) 265-0165
Mailing address
126 DAMASCUS RD, BRANFORD, CT 06405-3961
(860) 882-3268
(203) 265-0165
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
006512
CT
1041C0700X
Clinical Social Worker
Primary
006512
CT
Other
Enumeration date
08/31/2012
Last updated
07/21/2022
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