Provider Demographics
NPI:1841536869
Name:COUNSELING CENTER OF WATERBURY
Entity type:Organization
Organization Name:COUNSELING CENTER OF WATERBURY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCIL
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:203-596-7870
Mailing Address - Street 1:525 WOLCOTT ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-1240
Mailing Address - Country:US
Mailing Address - Phone:203-596-7870
Mailing Address - Fax:
Practice Address - Street 1:525 WOLCOTT ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-1240
Practice Address - Country:US
Practice Address - Phone:203-596-7870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001023101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty