Provider Demographics
NPI:1285457739
Name:WICHOWSKI, BARTOSZ (LPC-A)
Entity type:Individual
Prefix:
First Name:BARTOSZ
Middle Name:
Last Name:WICHOWSKI
Suffix:
Gender:M
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CANDLEWOOD HILL RD
Mailing Address - Street 2:
Mailing Address - City:HIGGANUM
Mailing Address - State:CT
Mailing Address - Zip Code:06441-4214
Mailing Address - Country:US
Mailing Address - Phone:203-631-7647
Mailing Address - Fax:
Practice Address - Street 1:433 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-2123
Practice Address - Country:US
Practice Address - Phone:646-470-4439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7045101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health