Provider Demographics
NPI:1992310379
Name:CHATTERSOUPE, PLLC
Entity type:Organization
Organization Name:CHATTERSOUPE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BELVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-734-5229
Mailing Address - Street 1:PO BOX 116
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:CT
Mailing Address - Zip Code:06237-0116
Mailing Address - Country:US
Mailing Address - Phone:860-734-5229
Mailing Address - Fax:
Practice Address - Street 1:1153 MAIN ST
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:CT
Practice Address - Zip Code:06238-3115
Practice Address - Country:US
Practice Address - Phone:860-734-5229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-11
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty