Provider Demographics
NPI:1427563550
Name:OAK TREE THERAPY PLLC
Entity type:Organization
Organization Name:OAK TREE THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SADIGHI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:475-223-2473
Mailing Address - Street 1:427 CHURCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-3837
Mailing Address - Country:US
Mailing Address - Phone:860-207-5388
Mailing Address - Fax:
Practice Address - Street 1:755 MAIN STREET, BUILDING #1
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468
Practice Address - Country:US
Practice Address - Phone:475-223-2473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003037251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1881081875Medicaid