Provider Demographics
NPI:1851767933
Name:WATERSTONE COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:WATERSTONE COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:BONO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:203-245-0412
Mailing Address - Street 1:86 BRADLEY RD STE 2
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2644
Mailing Address - Country:US
Mailing Address - Phone:203-245-0412
Mailing Address - Fax:203-245-0572
Practice Address - Street 1:86 BRADLEY RD STE 2
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2644
Practice Address - Country:US
Practice Address - Phone:203-245-0412
Practice Address - Fax:203-245-0572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2824103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Single Specialty