Provider Demographics
NPI: | 1942601000 |
---|---|
Name: | GREENWOODS COUNSELING REFERRALS, INC. |
Entity Type: | Organization |
Organization Name: | GREENWOODS COUNSELING REFERRALS, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CLINICAL COORDINATOR |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | ROBIN |
Authorized Official - Middle Name: | MATTIELLO |
Authorized Official - Last Name: | MIASEK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LCSW |
Authorized Official - Phone: | 860-567-4437 |
Mailing Address - Street 1: | 25 SOUTH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | LITCHFIELD |
Mailing Address - State: | CT |
Mailing Address - Zip Code: | 06759-4005 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 860-567-4437 |
Mailing Address - Fax: | 860-567-0300 |
Practice Address - Street 1: | 25 SOUTH ST |
Practice Address - Street 2: | |
Practice Address - City: | LITCHFIELD |
Practice Address - State: | CT |
Practice Address - Zip Code: | 06759-4005 |
Practice Address - Country: | US |
Practice Address - Phone: | 860-567-4437 |
Practice Address - Fax: | 860-567-0300 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-09-09 |
Last Update Date: | 2014-09-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CT | 8710 | 251S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |