Healthcare Provider Details

I. General information

NPI: 1093175135
Provider Name (Legal Business Name): HARBORSIDE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 06/02/2024
Certification Date: 06/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 BUTTONWOOD RD
HEBRON CT
06248-1551
US

IV. Provider business mailing address

76 BUTTONWOOD RD
HEBRON CT
06248-1551
US

V. Phone/Fax

Practice location:
  • Phone: 860-575-5552
  • Fax:
Mailing address:
  • Phone: 860-575-5552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number004320
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE A MORGAN
Title or Position: OWNER
Credential: LCSW
Phone: 860-575-5552