Provider Demographics
NPI:1629536768
Name:RUTH ETCHELLS SIBORG LPC LLC
Entity Type:Organization
Organization Name:RUTH ETCHELLS SIBORG LPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ETCHELLS
Authorized Official - Last Name:SIBORG
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-207-7464
Mailing Address - Street 1:36 HI LEA FARM RD
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-1779
Mailing Address - Country:US
Mailing Address - Phone:860-207-7464
Mailing Address - Fax:
Practice Address - Street 1:100 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-1138
Practice Address - Country:US
Practice Address - Phone:860-207-7464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty