Provider Demographics
NPI:1881965002
Name:SIDWAY COUNSELING, LLC
Entity type:Organization
Organization Name:SIDWAY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SIDWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:203-525-2091
Mailing Address - Street 1:76 WESTBURY PARK RD
Mailing Address - Street 2:SUITE 303E
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2779
Mailing Address - Country:US
Mailing Address - Phone:203-525-2091
Mailing Address - Fax:860-417-6099
Practice Address - Street 1:76 WESTBURY PARK RD
Practice Address - Street 2:SUITE 303E
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2779
Practice Address - Country:US
Practice Address - Phone:203-525-2091
Practice Address - Fax:860-417-6099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001484106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty