Healthcare Provider Details

I. General information

NPI: 1134478357
Provider Name (Legal Business Name): COVENANT FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 09/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 NEW HAVEN AVE
MILFORD CT
06460-3618
US

IV. Provider business mailing address

550 NEW HAVEN AVE
MILFORD CT
06460-3618
US

V. Phone/Fax

Practice location:
  • Phone: 203-446-1848
  • Fax: 203-283-7714
Mailing address:
  • Phone: 203-448-1848
  • Fax: 203-283-7714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007373
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number00004798
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. MARCEL W SLOWLY
Title or Position: PROPRIETOR
Credential: LMFT
Phone: 203-906-5161