Provider Demographics
NPI:1427615053
Name:FAMILY COUNSELING OF NEWINGTON, PLLC
Entity type:Organization
Organization Name:FAMILY COUNSELING OF NEWINGTON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:860-841-2559
Mailing Address - Street 1:39 MARKET SQ FL 2
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2912
Mailing Address - Country:US
Mailing Address - Phone:860-841-2559
Mailing Address - Fax:960-371-3488
Practice Address - Street 1:39 MARKET SQ FL 2
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2912
Practice Address - Country:US
Practice Address - Phone:860-841-2559
Practice Address - Fax:960-371-3488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002042OtherLCSW