Provider Demographics
NPI:1417711847
Name:KERITH BROOK COUNSELING, LLC
Entity Type:Organization
Organization Name:KERITH BROOK COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-288-7017
Mailing Address - Street 1:39 MILL ST STE 4
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-2359
Mailing Address - Country:US
Mailing Address - Phone:860-288-7017
Mailing Address - Fax:860-288-7017
Practice Address - Street 1:39 MILL ST STE 4
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-2359
Practice Address - Country:US
Practice Address - Phone:860-288-7017
Practice Address - Fax:860-288-7017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center