Provider Demographics
NPI:1811426562
Name:ELEONORA COREY COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:ELEONORA COREY COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELEONORA
Authorized Official - Middle Name:
Authorized Official - Last Name:COREY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:860-302-7918
Mailing Address - Street 1:115 MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4896
Mailing Address - Country:US
Mailing Address - Phone:860-302-7918
Mailing Address - Fax:
Practice Address - Street 1:91 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5817
Practice Address - Country:US
Practice Address - Phone:860-736-7397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-07
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
CT002738101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty