Basic Information
| Provider Information | |||||||||
| NPI: | 1922449628 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FAMILY JUNCTION BIRTH TO THREE | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 900 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | OAKVILLE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067791999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609453012 | ||||||||
| FaxNumber: | 8609459854 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | OAKVILLE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067791999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609453012 | ||||||||
| FaxNumber: | 8609459854 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2013 | ||||||||
| LastUpdateDate: | 07/10/2013 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RISIGO-WICKLINE | ||||||||
| AuthorizedOfficialFirstName: | CATHERINE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/CEO | ||||||||
| AuthorizedOfficialTelephone: | 2032179365 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THERAPY UNLIMITED LLC | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MS OTR/L | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 252Y00000X | 000752 | CT | Y | Agencies | Early Intervention Provider Agency |
No ID Information.