Healthcare Provider Details

I. General information

NPI: 1700668167
Provider Name (Legal Business Name): NEVADOMSKI COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2023
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

687 STRAITS TPKE STE 1C
MIDDLEBURY CT
06762-2846
US

IV. Provider business mailing address

67 SHANE DR
SOUTHBURY CT
06488-2678
US

V. Phone/Fax

Practice location:
  • Phone: 203-408-2420
  • Fax:
Mailing address:
  • Phone: 516-204-3196
  • Fax: 203-204-8480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: PAUL NEVADOMSKI
Title or Position: OFFICE MANAGER
Credential:
Phone: 203-408-2420