Provider Demographics
NPI:1265631923
Name:GEROWE, HARRY A (MS,LADC,CCS,CCDP)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:A
Last Name:GEROWE
Suffix:
Gender:M
Credentials:MS,LADC,CCS,CCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WATERTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2011
Mailing Address - Country:US
Mailing Address - Phone:203-756-8984
Mailing Address - Fax:203-756-8984
Practice Address - Street 1:900 WATERTOWN AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2011
Practice Address - Country:US
Practice Address - Phone:203-756-8984
Practice Address - Fax:203-756-8984
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000118101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCAC - 588OtherCONNECTICUT CERTIFICATION BOARD
CTCCS - 588OtherCONNECTICUT CERTIFICATION BOARD
CT000118OtherLICENSED ALCOHOL AND DRUG
CTCCDP - 4884OtherCONNECTICUT CERTIFICATION BOARD