Provider Demographics
NPI:1265829832
Name:GJ HARBILAS LCSW COUNSELING
Entity Type:Organization
Organization Name:GJ HARBILAS LCSW COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARBILAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-557-9333
Mailing Address - Street 1:728 POST RD E
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-5200
Mailing Address - Country:US
Mailing Address - Phone:203-557-9333
Mailing Address - Fax:203-557-9332
Practice Address - Street 1:728 POST RD E
Practice Address - Street 2:SUITE 205
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5200
Practice Address - Country:US
Practice Address - Phone:203-557-9333
Practice Address - Fax:203-557-9332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0057291041C0700X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1770756934OtherAPPLICATION FOR NPI 2 PRIVATE PRACTICE
CT1770756934OtherAPPLICATION FOR NPI 2 PRIVATE PRACTICE