| Waterbury Counseling Affiliates | |
|
1078 W Main St Waterbury CT 06708 | |
| (203) 753-8336 | |
| (203) 253-7618 |
| Full Name | Waterbury Counseling Affiliates |
|---|---|
| Speciality | Clinic/Center |
| Location | 1078 W Main St, Waterbury, Connecticut |
| Authorized Official Name and Position | Susan Coon Howard (PARTNER) |
| Authorized Official Contact | 2037538336 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Waterbury Counseling Affiliates 1078 West Main St Waterbury CT 06708 Ph: (203) 753-8336 | Waterbury Counseling Affiliates 1078 W Main St Waterbury CT 06708 Ph: (203) 753-8336 |
| NPI Number | 1780876078 |
|---|---|
| Provider Enumeration Date | 08/10/2007 |
| Last Update Date | 08/10/2007 |
| Medicare PECOS PAC ID | 1759558216 |
|---|---|
| Medicare Enrollment ID | O20120124000539 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780876078 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Susan C Howard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598758872 PECOS PAC ID: 3870767940 Enrollment ID: I20111130000109 |
| Provider Name | Kathleen M Boucher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023191756 PECOS PAC ID: 2264609726 Enrollment ID: I20170322000356 |
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