Provider Demographics
NPI:1790425387
Name:COMPASSIONATE COUNSELING AND CULINARY ARTS THERAPY LLC
Entity Type:Organization
Organization Name:COMPASSIONATE COUNSELING AND CULINARY ARTS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:AUDRA
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, PHD
Authorized Official - Phone:516-528-3831
Mailing Address - Street 1:15 CASSWAY RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-1214
Mailing Address - Country:US
Mailing Address - Phone:516-528-3831
Mailing Address - Fax:
Practice Address - Street 1:15 CASSWAY RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-1214
Practice Address - Country:US
Practice Address - Phone:516-528-3831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health