| Ruth Etchells Siborg Lpc Llc | |
|
100 Linwood Ave Colchester CT 06415-1138 | |
| (860) 207-7464 | |
| Not Available |
| Full Name | Ruth Etchells Siborg Lpc Llc |
|---|---|
| Speciality | Counselor |
| Location | 100 Linwood Ave, Colchester, Connecticut |
| Authorized Official Name and Position | Ruth Etchells Siborg (COUNSELOR) |
| Authorized Official Contact | 8602077464 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ruth Etchells Siborg Lpc Llc 36 Hi Lea Farm Rd Colchester CT 06415-1779 Ph: (860) 207-7464 | Ruth Etchells Siborg Lpc Llc 100 Linwood Ave Colchester CT 06415-1138 Ph: (860) 207-7464 |
| NPI Number | 1629536768 |
|---|---|
| Provider Enumeration Date | 03/07/2019 |
| Last Update Date | 03/07/2019 |
| Medicare PECOS PAC ID | 5698110138 |
|---|---|
| Medicare Enrollment ID | O20240223003612 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629536768 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Ruth Siborg |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1881139525 PECOS PAC ID: 2860837309 Enrollment ID: I20240223003742 |
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