Provider Demographics
NPI:1083038087
Name:SEBASTIAN A. PERUMBILLY PHD
Entity type:Organization
Organization Name:SEBASTIAN A. PERUMBILLY PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMFT
Authorized Official - Prefix:
Authorized Official - First Name:SEBASTIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PERUMBILLY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-483-6860
Mailing Address - Street 1:11112 TOWN WALK DR
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3722
Mailing Address - Country:US
Mailing Address - Phone:206-446-8865
Mailing Address - Fax:203-483-6861
Practice Address - Street 1:94 N BRANFORD RD
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-2811
Practice Address - Country:US
Practice Address - Phone:203-483-6860
Practice Address - Fax:203-483-6861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1532106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty