Healthcare Provider Details

I. General information

NPI: 1811970080
Provider Name (Legal Business Name): JOHN PETER VERONESI LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 ROBBINS ST CRISIS INTERVENTION CENTER
WATERBURY CT
06708-2613
US

IV. Provider business mailing address

10 WESTSIDE RD PO BOX 158
NORFOLK CT
06058-1209
US

V. Phone/Fax

Practice location:
  • Phone: 203-573-6500
  • Fax: 203-573-7007
Mailing address:
  • Phone: 860-542-3934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001047
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: