1649365834 NPI number — DR. LOUISA L FOSS PH.D., N.C.C., L.P.C

Table of content: DR. LOUISA L FOSS PH.D., N.C.C., L.P.C (NPI 1649365834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649365834 NPI number — DR. LOUISA L FOSS PH.D., N.C.C., L.P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOSS
Provider First Name:
LOUISA
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D., N.C.C., L.P.C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FOSS-PIERCE
Provider Other First Name:
LOUISA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED., LPCC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649365834
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42 EAST HIGH STREET
Provider Second Line Business Mailing Address:
SUITE 201, AVIA COUNSELING CENTER
Provider Business Mailing Address City Name:
EAST HAMPTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-267-2687
Provider Business Mailing Address Fax Number:
860-267-2709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42 EAST HIGH STREET
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
EAST HAMPTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-267-2687
Provider Business Practice Location Address Fax Number:
860-267-2709
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  001846 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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