Provider Demographics
NPI:1811068893
Name:CHRISTIAN COUNSELING CENTER OF GREATER DANBURY INC
Entity type:Organization
Organization Name:CHRISTIAN COUNSELING CENTER OF GREATER DANBURY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FUSCO
Authorized Official - Suffix:
Authorized Official - Credentials:RN MHCNS
Authorized Official - Phone:203-775-3282
Mailing Address - Street 1:2 OLD NEW MILFORD ROAD
Mailing Address - Street 2:LANDMARK OFFICE BUILDING SUITE 2A
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2426
Mailing Address - Country:US
Mailing Address - Phone:203-775-3282
Mailing Address - Fax:203-775-3478
Practice Address - Street 1:2 OLD NEW MILFORD ROAD
Practice Address - Street 2:LANDMARK OFFICE BUILDING SUITE 2A
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2426
Practice Address - Country:US
Practice Address - Phone:203-775-3282
Practice Address - Fax:203-775-3478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 104100000X, 101Y00000X
CT006329363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008007955Medicaid
CT004258077Medicaid
CT008062840Medicaid