Basic Information
| Provider Information | |||||||||
| NPI: | 1174615827 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATES FOR RESOLUTIONTHERAPY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 HARBOR RD | ||||||||
| Address2: | |||||||||
| City: | SOUTHPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068901316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032548262 | ||||||||
| FaxNumber: | 2032552512 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 HARBOR RD | ||||||||
| Address2: | |||||||||
| City: | SOUTHPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068901316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032548262 | ||||||||
| FaxNumber: | 2032552512 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | TRUEBLOOD | ||||||||
| AuthorizedOfficialFirstName: | PAULETTE | ||||||||
| AuthorizedOfficialMiddleName: | KAY | ||||||||
| AuthorizedOfficialTitleorPosition: | FAMILY THERAPIST AND OWNER OF LLC | ||||||||
| AuthorizedOfficialTelephone: | 2032548268 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | M.A,, L.M.F.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 000786 | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.