Healthcare Provider Details

I. General information

NPI: 1679229769
Provider Name (Legal Business Name): AUTHENTIC-SELF COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2022
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 FARMS VILLAGE RD UNIT 305
WEST SIMSBURY CT
06092-7713
US

IV. Provider business mailing address

239 FARMS VILLAGE RD UNIT 305
WEST SIMSBURY CT
06092-7713
US

V. Phone/Fax

Practice location:
  • Phone: 860-325-7344
  • Fax:
Mailing address:
  • Phone: 860-325-7344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SUSAN CAROL EISENBERG
Title or Position: OWNER
Credential:
Phone: 860-325-7344