Provider Demographics
NPI:1104584507
Name:TAVERAS, ERIC ANTHONY (MS)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:ANTHONY
Last Name:TAVERAS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:MR
Other - First Name:ERIC
Other - Middle Name:ANTHONY
Other - Last Name:TAVERAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ERIC TAVERAS MS,LPCA
Mailing Address - Street 1:27 CROWS NEST LN UNIT 17J
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-2016
Mailing Address - Country:US
Mailing Address - Phone:203-300-0780
Mailing Address - Fax:
Practice Address - Street 1:27 CROWS NEST LN UNIT 17J
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-2016
Practice Address - Country:US
Practice Address - Phone:203-300-0780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101YP1600X, 101YA0400X
CT5281101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)