Individual
MRS. IVY MARIYAM THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
900 MAIN ST S STE 201, SOUTHBURY, CT 06488-2224
(203) 255-5078
Mailing address
9 WALNUT RIDGE RD, NEW FAIRFIELD, CT 06812-3214
(475) 296-8690
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6939
CT
Other
Enumeration date
06/03/2025
Last updated
06/03/2025
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