Provider Demographics
NPI:1235402744
Name:ESTUARY COUNSELING LLC
Entity Type:Organization
Organization Name:ESTUARY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:PLYER
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:860-853-2220
Mailing Address - Street 1:35 EDMUND ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-2422
Mailing Address - Country:US
Mailing Address - Phone:860-304-1442
Mailing Address - Fax:
Practice Address - Street 1:35 EDMUND ST
Practice Address - Street 2:SUITE A
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-2422
Practice Address - Country:US
Practice Address - Phone:860-304-1442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0055451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty