Provider Demographics
NPI:1700424967
Name:INSIGHT COUNSELING GROUP, LLC
Entity Type:Organization
Organization Name:INSIGHT COUNSELING GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:VERNON
Authorized Official - Last Name:BUKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:302-593-4598
Mailing Address - Street 1:386 PROSPECT ST APT A1
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2117
Mailing Address - Country:US
Mailing Address - Phone:302-593-4598
Mailing Address - Fax:434-595-6198
Practice Address - Street 1:261 BRADLEY ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510
Practice Address - Country:US
Practice Address - Phone:434-270-0571
Practice Address - Fax:434-595-6198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-18
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251X00000XAgenciesSupports BrokerageGroup - Multi-Specialty