Healthcare Provider Details

I. General information

NPI: 1376785808
Provider Name (Legal Business Name): ENHANCING BEHAVIORAL CHOICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1169 ELLINGTON RD
SOUTH WINDSOR CT
06074-3515
US

IV. Provider business mailing address

1169 ELLINGTON RD
SOUTH WINDSOR CT
06074-3515
US

V. Phone/Fax

Practice location:
  • Phone: 860-289-4404
  • Fax: 860-289-4402
Mailing address:
  • Phone: 860-289-4404
  • Fax: 860-289-4402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCT

VIII. Authorized Official

Name: MS. ROBIN J. SURWILO
Title or Position: OWNER, ENHANCING BEHAVIORAL CHOICES
Credential: PH.D.
Phone: 860-289-4404