Provider Demographics
NPI:1902969462
Name:SOUTHERN CONNECTICUT COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:SOUTHERN CONNECTICUT COUNSELING SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDFARB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-220-2208
Mailing Address - Street 1:477 MAIN ST STE 208
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-1139
Mailing Address - Country:US
Mailing Address - Phone:203-220-2208
Mailing Address - Fax:203-220-2247
Practice Address - Street 1:477 MAIN ST STE 208
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-1139
Practice Address - Country:US
Practice Address - Phone:203-220-2208
Practice Address - Fax:203-220-2247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000418101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty