Provider Demographics
NPI:1700668167
Name:NEVADOMSKI COUNSELING LLC
Entity Type:Organization
Organization Name:NEVADOMSKI COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:NEVADOMSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-204-3196
Mailing Address - Street 1:67 SHANE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2678
Mailing Address - Country:US
Mailing Address - Phone:516-204-3196
Mailing Address - Fax:
Practice Address - Street 1:67 SHANE DR
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2678
Practice Address - Country:US
Practice Address - Phone:203-632-9818
Practice Address - Fax:203-204-8480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-19
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty