Healthcare Provider Details

I. General information

NPI: 1700790292
Provider Name (Legal Business Name): PEARL HAVEN COUNSELING FOR MENTAL & BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 CARPENTER LN
BLOOMFIELD CT
06002-1818
US

IV. Provider business mailing address

4 CARPENTER LN
BLOOMFIELD CT
06002-1818
US

V. Phone/Fax

Practice location:
  • Phone: 860-922-0649
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: PHILLIPIA POTTINGER
Title or Position: CLINICIAN & CEO
Credential: LCSW
Phone: 860-922-0649