Basic Information
| Provider Information | |||||||||
| NPI: | 1114048568 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ML THERAPIES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 CEDAR ST | ||||||||
| Address2: | |||||||||
| City: | NEW BRITAIN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060521302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606120432 | ||||||||
| FaxNumber: | 8606120087 | ||||||||
| Practice Location | |||||||||
| Address1: | 14 CEDAR ST | ||||||||
| Address2: | |||||||||
| City: | NEW BRITAIN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060521302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606120432 | ||||||||
| FaxNumber: | 8606120087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GRAHAM | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | LOU | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER LLC | ||||||||
| AuthorizedOfficialTelephone: | 8606120432 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | APRN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 003146 | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.