Healthcare Provider Details

I. General information

NPI: 1285457739
Provider Name (Legal Business Name): BARTOSZ WICHOWSKI LPC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 SILAS DEANE HWY
WETHERSFIELD CT
06109-2123
US

IV. Provider business mailing address

700 CANDLEWOOD HILL RD
HIGGANUM CT
06441-4214
US

V. Phone/Fax

Practice location:
  • Phone: 646-470-4439
  • Fax:
Mailing address:
  • Phone: 203-631-7647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7045
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: