Provider Demographics
NPI:1558675454
Name:WESTRY, ERIC (EDM, MS, MA)
Entity Type:Individual
Prefix:PROF
First Name:ERIC
Middle Name:
Last Name:WESTRY
Suffix:
Gender:M
Credentials:EDM, MS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61-09 BENTWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-3615
Mailing Address - Country:US
Mailing Address - Phone:203-565-6393
Mailing Address - Fax:
Practice Address - Street 1:61-09 BENTWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-3615
Practice Address - Country:US
Practice Address - Phone:203-565-6393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001310101YA0400X, 101YM0800X, 101YP2500X, 101YS0200X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist