Provider Demographics
NPI:1366026874
Name:PHOENIX RISING COUNSELING
Entity Type:Organization
Organization Name:PHOENIX RISING COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMEROTA-MACNEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-792-6396
Mailing Address - Street 1:116 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:PASCOAG
Mailing Address - State:RI
Mailing Address - Zip Code:02859-3249
Mailing Address - Country:US
Mailing Address - Phone:401-533-1710
Mailing Address - Fax:
Practice Address - Street 1:28A MASHAMOQUET RD
Practice Address - Street 2:
Practice Address - City:POMFRET CENTER
Practice Address - State:CT
Practice Address - Zip Code:06259-1813
Practice Address - Country:US
Practice Address - Phone:860-792-6396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty