Provider Demographics
NPI:1982955050
Name:COUNSELING CENTERS OF NEW ENGLAND LLC
Entity Type:Organization
Organization Name:COUNSELING CENTERS OF NEW ENGLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOURQUE
Authorized Official - Suffix:JR
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-990-9870
Mailing Address - Street 1:40 AVON MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3753
Mailing Address - Country:US
Mailing Address - Phone:860-990-9870
Mailing Address - Fax:
Practice Address - Street 1:40 AVON MEADOW LN
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3753
Practice Address - Country:US
Practice Address - Phone:860-990-9870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5047363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty