Healthcare Provider Details

I. General information

NPI: 1063139855
Provider Name (Legal Business Name): LAURA J NESTA BLUEBIRD COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 STRAITS TPKE STE C106
MIDDLEBURY CT
06762-2865
US

IV. Provider business mailing address

124 MAYBROOK RD
WATERBURY CT
06708-3234
US

V. Phone/Fax

Practice location:
  • Phone: 203-592-4718
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHERYL DULINA
Title or Position: OFFICE MANAGER
Credential:
Phone: 203-910-9915