Provider Demographics
NPI:1275092777
Name:EMPOWER COUNSELING AND THERAPY, PLLC
Entity Type:Organization
Organization Name:EMPOWER COUNSELING AND THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA LOU
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-710-8815
Mailing Address - Street 1:24 QUEEN ELEANOR DR
Mailing Address - Street 2:
Mailing Address - City:GALES FERRY
Mailing Address - State:CT
Mailing Address - Zip Code:06335-1315
Mailing Address - Country:US
Mailing Address - Phone:860-710-8815
Mailing Address - Fax:860-464-2806
Practice Address - Street 1:12 CASE ST STE 201
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2222
Practice Address - Country:US
Practice Address - Phone:860-710-8815
Practice Address - Fax:860-464-2806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008023926Medicaid