Healthcare Provider Details

I. General information

NPI: 1568592293
Provider Name (Legal Business Name): HUMAN SERVICES COUNCIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 MAIN AVE BRIGGS HIGH SCHOOL SBHC
NORWALK CT
06851-1510
US

IV. Provider business mailing address

1 PARK ST - 2ND FLOOR
NORWALK CT
06851-4841
US

V. Phone/Fax

Practice location:
  • Phone: 203-846-6385
  • Fax: 203-846-6395
Mailing address:
  • Phone: 203-849-1111
  • Fax: 203-849-1151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number0315
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0315
License Number StateCT

VIII. Authorized Official

Name: MR. ANTHONY DILAURO
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 203-849-1111