Provider Demographics
NPI:1659078368
Name:HERITAGE COUNSELING AFFILIATES
Entity Type:Organization
Organization Name:HERITAGE COUNSELING AFFILIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-919-6770
Mailing Address - Street 1:250 POMEROY AVE STE 201A
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-8316
Mailing Address - Country:US
Mailing Address - Phone:860-919-6770
Mailing Address - Fax:
Practice Address - Street 1:250 POMEROY AVE STE 201A
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-8316
Practice Address - Country:US
Practice Address - Phone:860-919-6770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty