Provider Demographics
NPI:1003053125
Name:STONEY BROOK COUNSELING CENTER
Entity Type:Organization
Organization Name:STONEY BROOK COUNSELING CENTER
Other - Org Name:STONEY BROOK COUNSELING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WINDT
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:978-275-9444
Mailing Address - Street 1:2 CTHOUSE LN UN
Mailing Address - Street 2:SUITE #3
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-1715
Mailing Address - Country:US
Mailing Address - Phone:978-275-9444
Mailing Address - Fax:
Practice Address - Street 1:2 CTHOUSE LN UN
Practice Address - Street 2:SUITE #3
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1715
Practice Address - Country:US
Practice Address - Phone:978-275-9444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPREHENSIVE OUTPATIENT SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health