Provider Demographics
NPI:1790839082
Name:BITTERS, JOHN (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:BITTERS
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 MOHEGAN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4125
Mailing Address - Country:US
Mailing Address - Phone:860-439-2249
Mailing Address - Fax:860-439-2317
Practice Address - Street 1:270 MOHEGAN AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4125
Practice Address - Country:US
Practice Address - Phone:860-439-2249
Practice Address - Fax:860-439-2317
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000040101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional