Provider Demographics
NPI:1891860300
Name:PASTORAL COUNSELING CENTER OF WEST HARTFORD
Entity Type:Organization
Organization Name:PASTORAL COUNSELING CENTER OF WEST HARTFORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:W
Authorized Official - Last Name:BAMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, PASTORAL PSYCH
Authorized Official - Phone:860-233-0548
Mailing Address - Street 1:12 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2406
Mailing Address - Country:US
Mailing Address - Phone:860-233-0548
Mailing Address - Fax:860-236-0253
Practice Address - Street 1:12 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2406
Practice Address - Country:US
Practice Address - Phone:860-233-0548
Practice Address - Fax:860-236-0253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC0231101YA0400X, 101YP2500X, 103TC0700X, 1041C0700X, 106H00000X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Not Answered163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4173928Medicaid
CT4173928Medicaid