Provider Demographics
NPI:1003376096
Name:SIMSBURY COUNSELING CENTER PLLC
Entity Type:Organization
Organization Name:SIMSBURY COUNSELING CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MOWRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-918-2678
Mailing Address - Street 1:1 MILL POND LANE SUITE 9
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-2485
Mailing Address - Country:US
Mailing Address - Phone:860-918-2678
Mailing Address - Fax:
Practice Address - Street 1:1 MILL POND LANE SUITE 9
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-2485
Practice Address - Country:US
Practice Address - Phone:860-952-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT006042OtherLCSW
CT004263787Medicaid