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General NPI Number Information
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NPI Number | 1003574245
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Entity Type | Organization
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Legal Business Name | CB COUNSELING PLLC
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Dates
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Enumeration Date | 12/06/2021
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 425 KINGS HWY E
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City | FAIRFIELD
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State | CT
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Zip | 06825-4852
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Country | US
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Telephone | 203-307-0119
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Fax |
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Provider Business Mailing Address
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Address Line | 516 WOODRIDGE AVE
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City | FAIRFIELD
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State | CT
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Zip | 06825-2577
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Country | US
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Telephone | 203-247-9039
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | CODY BERGERON
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Credential | LCSW
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Telephone | 203-307-0119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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