Provider Demographics
NPI:1710748850
Name:PSYCHOTHERAPY CENTER FOR GRIEF AND HOSPICE COUNSELING, LLC
Entity Type:Organization
Organization Name:PSYCHOTHERAPY CENTER FOR GRIEF AND HOSPICE COUNSELING, LLC
Other - Org Name:PSYCHOTHERAPY CENTER FOR GRIEF AND HOSPICE COUNSELING , LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BIDOSSESSI(BIDO)
Authorized Official - Middle Name:E
Authorized Official - Last Name:AGUESSY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:973-873-3933
Mailing Address - Street 1:16 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3016
Mailing Address - Country:US
Mailing Address - Phone:973-873-3933
Mailing Address - Fax:
Practice Address - Street 1:151 NEW PARK AVE STE 120
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2174
Practice Address - Country:US
Practice Address - Phone:973-873-3933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty