| Authentic -self Counseling, Llc | |
|
35 E Main St Ste 125 Avon CT 06001-3845 | |
| (860) 325-7344 | |
| Not Available |
| Full Name | Authentic -self Counseling, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 35 E Main St Ste 125, Avon, Connecticut |
| Authorized Official Name and Position | Susan Eisenberg (MEMBER) |
| Authorized Official Contact | 8603257344 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Authentic -self Counseling, Llc 35 E Main St Ste 125 Avon CT 06001-3845 Ph: (860) 325-7344 | Authentic -self Counseling, Llc 35 E Main St Ste 125 Avon CT 06001-3845 Ph: (860) 325-7344 |
| NPI Number | 1679229769 |
|---|---|
| Provider Enumeration Date | 02/27/2022 |
| Last Update Date | 06/22/2022 |
| Certification Date | 06/22/2022 |
| Medicare PECOS PAC ID | 2264828193 |
|---|---|
| Medicare Enrollment ID | O20220401001335 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679229769 | NPI | - | NPPES |
| 1013660174 | Other | CT | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Susan Eisenberg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013660174 PECOS PAC ID: 7113313651 Enrollment ID: I20220408001164 |
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