Provider Demographics
NPI:1528357761
Name:CHRISTIAN COUNSELING OF GREATER WATERBURY
Entity Type:Organization
Organization Name:CHRISTIAN COUNSELING OF GREATER WATERBURY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CIUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-758-3570
Mailing Address - Street 1:2 SUMMIT RD
Mailing Address - Street 2:SUITE L
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1426
Mailing Address - Country:US
Mailing Address - Phone:203-758-3570
Mailing Address - Fax:203-758-3570
Practice Address - Street 1:2 SUMMIT RD
Practice Address - Street 2:SUITE L
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712-1426
Practice Address - Country:US
Practice Address - Phone:203-758-3570
Practice Address - Fax:203-758-3570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001625101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty