Provider Demographics
NPI:1750633285
Name:FAIRFIELD COUNSELING GROUP LLC
Entity type:Organization
Organization Name:FAIRFIELD COUNSELING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:ANGELICA
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:917-543-2209
Mailing Address - Street 1:7 DAHLIA LN
Mailing Address - Street 2:
Mailing Address - City:WEST REDDING
Mailing Address - State:CT
Mailing Address - Zip Code:06896-1421
Mailing Address - Country:US
Mailing Address - Phone:203-948-4126
Mailing Address - Fax:203-612-9830
Practice Address - Street 1:35 KINGS HWY E
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-4873
Practice Address - Country:US
Practice Address - Phone:203-948-4126
Practice Address - Fax:203-612-9830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty