Healthcare Provider Details

I. General information

NPI: 1669776043
Provider Name (Legal Business Name): CARL HEINEMEYER COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2010
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 BARNABAS RD STE 11
HAWLEYVILLE CT
06440-1201
US

IV. Provider business mailing address

23 BARNABAS RD STE 11
HAWLEYVILLE CT
06440-1201
US

V. Phone/Fax

Practice location:
  • Phone: 203-240-6306
  • Fax: 203-205-0920
Mailing address:
  • Phone: 203-240-6306
  • Fax: 203-205-0920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number003064
License Number StateCT

VIII. Authorized Official

Name: MR. CARL P HEINEMEYER
Title or Position: AUTHORIZED OFFICIAL
Credential: LCSW
Phone: 203-240-6303