| Prosperity Counseling, Llc | |
|
1423 Chapel St Ste 1b New Haven CT 06511-4411 | |
| (203) 908-8978 | |
| Not Available |
| Full Name | Prosperity Counseling, Llc |
|---|---|
| Speciality | Counselor |
| Location | 1423 Chapel St Ste 1b, New Haven, Connecticut |
| Authorized Official Name and Position | Karen Michelle Tyson (OWNER) |
| Authorized Official Contact | 2039088978 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prosperity Counseling, Llc 1580 Chapel St New Haven CT 06511-4205 Ph: (203) 908-8978 | Prosperity Counseling, Llc 1423 Chapel St Ste 1b New Haven CT 06511-4411 Ph: (203) 908-8978 |
| NPI Number | 1700417441 |
|---|---|
| Provider Enumeration Date | 01/31/2020 |
| Last Update Date | 04/02/2024 |
| Certification Date | 10/20/2021 |
| Medicare PECOS PAC ID | 4284075565 |
|---|---|
| Medicare Enrollment ID | O20240517000986 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700417441 | NPI | - | NPPES |
| 004235918 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
| Provider Name | Eni V Smith |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1659786275 PECOS PAC ID: 6002033438 Enrollment ID: I20190115003201 |
| Provider Name | Eulah Lacey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134735210 PECOS PAC ID: 3072926617 Enrollment ID: I20201229000308 |
| Provider Name | Richard Austin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1508138652 PECOS PAC ID: 3779921580 Enrollment ID: I20240329000155 |
| Provider Name | Isaiah Darnell Dockett |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043924178 PECOS PAC ID: 6305288507 Enrollment ID: I20240520001949 |
| Provider Name | Tracey Jones Otero |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1376238287 PECOS PAC ID: 6507208311 Enrollment ID: I20240524001874 |
| Provider Name | Justine Dimaria |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1457115040 PECOS PAC ID: 0749622041 Enrollment ID: I20240531000225 |
| Provider Name | Debra Cannon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1538756283 PECOS PAC ID: 1557803657 Enrollment ID: I20240604003529 |
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