Provider Demographics
NPI:1457492993
Name:SHVARTSMAN, ALEXANDER (MA, LADC, CCDP)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:SHVARTSMAN
Suffix:
Gender:M
Credentials:MA, LADC, CCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 GREENWOOD AVE
Mailing Address - Street 2:SUITE #6
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-2527
Mailing Address - Country:US
Mailing Address - Phone:203-743-4112
Mailing Address - Fax:203-743-6464
Practice Address - Street 1:153 GREENWOOD AVE
Practice Address - Street 2:SUITE #6
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-2527
Practice Address - Country:US
Practice Address - Phone:203-743-4112
Practice Address - Fax:203-743-6464
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000648101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)