Provider Demographics
NPI:1710480132
Name:CONTEMPORARY CARE COUNSELING
Entity Type:Organization
Organization Name:CONTEMPORARY CARE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-952-2919
Mailing Address - Street 1:84 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6047
Mailing Address - Country:US
Mailing Address - Phone:203-792-0400
Mailing Address - Fax:203-792-0400
Practice Address - Street 1:81 HOLLY HILL LN
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6071
Practice Address - Country:US
Practice Address - Phone:203-321-5063
Practice Address - Fax:203-769-1313
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONTEMPORARY CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039232101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1366971855OtherNATIONAL PROVIDER IDENTIFICATION
CT1730195751OtherNATIONAL PROVIDER IDENTIFICATION
CT1891159331OtherNATIONAL PROVIDER IDENTIFICATION
CT1912269333OtherNATIONAL PROVIDER IDENTIFICATION
CT1659570281OtherNATIONAL PROVIDER IDENTIFICATION