Provider Demographics
NPI:1215472527
Name:NUTMEG COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:NUTMEG COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:B
Authorized Official - Last Name:BOSCO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:475-238-8229
Mailing Address - Street 1:41 MIDDLETOWN AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3926
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41 MIDDLETOWN AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3926
Practice Address - Country:US
Practice Address - Phone:475-238-8229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-21
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002047101Y00000X
CT0069911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty