Provider Demographics
NPI:1841428711
Name:RIVERSIDE COUNSELING, LLC
Entity Type:Organization
Organization Name:RIVERSIDE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOWARD-ARLIA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-440-6201
Mailing Address - Street 1:1 FORT HILL RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-4799
Mailing Address - Country:US
Mailing Address - Phone:860-440-6201
Mailing Address - Fax:860-440-6778
Practice Address - Street 1:1 FORT HILL RD
Practice Address - Street 2:SUITE 3
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-4799
Practice Address - Country:US
Practice Address - Phone:860-440-6201
Practice Address - Fax:860-440-6778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0062251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800004191Medicare UPIN