Provider Demographics
NPI:1235658311
Name:PIECED TOGETHER THERAPEUTIC ASSOCIATES, LLC
Entity type:Organization
Organization Name:PIECED TOGETHER THERAPEUTIC ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMASSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-961-2995
Mailing Address - Street 1:764 COLONEL LEDYARD HWY UNIT 204
Mailing Address - Street 2:
Mailing Address - City:LEDYARD
Mailing Address - State:CT
Mailing Address - Zip Code:06339-7012
Mailing Address - Country:US
Mailing Address - Phone:860-961-2995
Mailing Address - Fax:
Practice Address - Street 1:764 COLONEL LEDYARD HWY UNIT 204
Practice Address - Street 2:
Practice Address - City:LEDYARD
Practice Address - State:CT
Practice Address - Zip Code:06339-7012
Practice Address - Country:US
Practice Address - Phone:860-961-2995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3263251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health