Basic Information
| Provider Information | |||||||||
| NPI: | 1982078796 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARYCH | ||||||||
| FirstName: | MAURA | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | FRITZ | ||||||||
| OtherFirstName: | MAURA | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 166 CHRISTIAN STREET | ||||||||
| Address2: | |||||||||
| City: | BRIDGEWATER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067521504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609651938 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1214 POST RD | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068246008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037434412 | ||||||||
| FaxNumber: | 2037381188 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2015 | ||||||||
| LastUpdateDate: | 09/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 3828 | CT | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.