Provider Demographics
NPI:1841672821
Name:BOROSKI, MARK R (LMFT,LADC, MA,BS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:BOROSKI
Suffix:
Gender:M
Credentials:LMFT,LADC, MA,BS
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7720
Mailing Address - Street 2:CREDENTIALING SPECIALIST
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-0720
Mailing Address - Country:US
Mailing Address - Phone:203-503-3174
Mailing Address - Fax:203-503-3183
Practice Address - Street 1:400 COLUMBUS AVENUE
Practice Address - Street 2:ADULT PSYCHIATRIC CLINIC
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1233
Practice Address - Country:US
Practice Address - Phone:203-503-3075
Practice Address - Fax:203-503-3296
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT1194101YA0400X
CT1951106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008065074Medicaid
CT060669107OtherHEALTHYCT WELLMORE GRP/FACILITY
CTNOT ELIGIBLEOtherCIGNA BEHAVIORAL HEALTH
CTNOT ELIGIBLEOtherMHN TRICARENORTH
CT060669107OtherOPTUM BEHAVIORAL HEALTH-UBH WELLMORE FACILITY/GRP
CT060669107OtherUBH-OXFORD FREEDOM/LIBERTY WELLMORE GRP/FACILITY
CTCAC-6129OtherCCB-CERTIFIED ADDICTION COUNSELOR
CT060669107OtherUBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY
CT10450310 402 E MAINOtherBEACON HEALTH STRATEGIES
CT060669107OtherANTHEM BCBS OF CT WELLMORE GRP/FACILITY
CTNOT ELIGIBLEOtherMHN MANAGED HEALTH NETWORK
CTICADC-6129OtherCCB- INTERNATIONALLY CERTIFIED ADDICTION COUNSELOR
CT060669107OtherUBH-CONNECTICARE WELLMORE GRP/FACILITY
CT13823195OtherCAQH
CTPENDINGOtherAETNA BEHAVIORAL HEALTH
CTNOT ELIGIBLEOtherMHN MANAGED HEALTH NETWORK