Provider Demographics
NPI:1962884676
Name:UNGAR, JUSTIN (MS, LPC, NCC)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:UNGAR
Suffix:
Gender:M
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WHITLOCK AVE
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-2817
Mailing Address - Country:US
Mailing Address - Phone:203-493-6550
Mailing Address - Fax:
Practice Address - Street 1:35 PORTER AVE
Practice Address - Street 2:SUITE 5B
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-1973
Practice Address - Country:US
Practice Address - Phone:203-493-6550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2770101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional