Provider Demographics
NPI:1689788580
Name:TOWN NORTH BRANFORD COUNSELING SERVICES
Entity Type:Organization
Organization Name:TOWN NORTH BRANFORD COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW LCSW
Authorized Official - Phone:203-315-6014
Mailing Address - Street 1:PO BOX 287
Mailing Address - Street 2:909 FOXON ROAD
Mailing Address - City:NORTH BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06471-0287
Mailing Address - Country:US
Mailing Address - Phone:203-315-6014
Mailing Address - Fax:
Practice Address - Street 1:1599 FOXON ROAD
Practice Address - Street 2:
Practice Address - City:NORTH BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06471-0287
Practice Address - Country:US
Practice Address - Phone:203-315-6014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT03431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty