Provider Demographics
NPI:1386197010
Name:SERENITY COUNSELING LLC
Entity Type:Organization
Organization Name:SERENITY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLEY
Authorized Official - Middle Name:CHARMAINE
Authorized Official - Last Name:PHILLIPS-LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-843-0162
Mailing Address - Street 1:32 HOBSON AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-2506
Mailing Address - Country:US
Mailing Address - Phone:203-843-0162
Mailing Address - Fax:203-230-2415
Practice Address - Street 1:270 AMITY RD
Practice Address - Street 2:SUITE 130
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2236
Practice Address - Country:US
Practice Address - Phone:203-843-0162
Practice Address - Fax:203-230-2415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty