Provider Demographics
NPI:1700407731
Name:DANBURY HEALING INSIGHTS COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:DANBURY HEALING INSIGHTS COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/ OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AGUSTINA
Authorized Official - Middle Name:HORTEL-RIOS
Authorized Official - Last Name:HORTEL-RIOS LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:914-625-2641
Mailing Address - Street 1:100 MILL PLAIN RD FL 3
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-5178
Mailing Address - Country:US
Mailing Address - Phone:914-625-2641
Mailing Address - Fax:
Practice Address - Street 1:100 MILL PLAIN RD FL 3
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-5178
Practice Address - Country:US
Practice Address - Phone:914-625-2641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008092796Medicaid