Organization
PEAK LONGEVITY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH MARCUS, LCSW LCSW (DIRECTOR, LCSW)
(203) 281-4325
Entity
Organization
Contact information
Practice address
451 STATE ST, NORTH HAVEN, CT 06473-3070
(203) 281-4325
(203) 281-4324
Mailing address
451 STATE ST, NORTH HAVEN, CT 06473-3070
(203) 281-4325
(203) 281-4324
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
005904
CT
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
005904
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140005904CT03
ANTHEM BCBS
CT
Enumeration date
04/30/2018
Last updated
04/30/2018
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