Provider Demographics
NPI:1316289531
Name:JONATHAN STERN, M.S., L.P.C., L.A.D.C., COUNSELING AND PSYCHOTHERAPY S
Entity type:Organization
Organization Name:JONATHAN STERN, M.S., L.P.C., L.A.D.C., COUNSELING AND PSYCHOTHERAPY S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LADC
Authorized Official - Phone:203-213-9987
Mailing Address - Street 1:2911 DIXWELL AVE
Mailing Address - Street 2:SUITE B-5
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3195
Mailing Address - Country:US
Mailing Address - Phone:203-916-5496
Mailing Address - Fax:203-265-1216
Practice Address - Street 1:2911 DIXWELL AVE
Practice Address - Street 2:SUITE B-5
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3195
Practice Address - Country:US
Practice Address - Phone:203-916-5496
Practice Address - Fax:203-265-1216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001882251S00000X
CT000823251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT12094074OtherCAQH
CT004235918Medicaid
CT1018781OtherCIGNA PROVIDER ID