Healthcare Provider Details

I. General information

NPI: 1770151748
Provider Name (Legal Business Name): CAUSEWAY COLLABORATIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 POST RD E STE 201
WESTPORT CT
06880-5528
US

IV. Provider business mailing address

1465 POST RD E STE 201
WESTPORT CT
06880-5528
US

V. Phone/Fax

Practice location:
  • Phone: 203-255-0301
  • Fax:
Mailing address:
  • Phone: 203-255-0301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. VINCENT BENEVENTO JR.
Title or Position: DIRECTOR
Credential: LPC
Phone: 203-927-3713