Organization
WE-MPACT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BETTE J KOZAK LPC (CLINICAL DIRECTOR)
(860) 940-4838
Entity
Organization
Contact information
Practice address
258 MIDDLE ST, SUITE C, BRISTOL, CT 06010-7492
(860) 940-4838
Mailing address
258 MIDDLE ST, SUITE C, BRISTOL, CT 06010-7492
(860) 940-4838
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
000562
CT
251S00000X
Community/Behavioral Health Agency
Primary
000562
CT
Other
Enumeration date
04/19/2010
Last updated
04/19/2010
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