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General NPI Number Information
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NPI Number | 1215472527
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Entity Type | Organization
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Legal Business Name | NUTMEG COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 12/21/2016
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Last Update Date | 01/26/2017
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Provider Practice Location Address
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Address Line | 41 MIDDLETOWN AVE 2ND FLOOR
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City | NORTH HAVEN
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State | CT
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Zip | 06473-3926
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Country | US
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Telephone | 475-238-8229
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Fax |
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Provider Business Mailing Address
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Address Line | 41 MIDDLETOWN AVE 2ND FLOOR
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City | NORTH HAVEN
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State | CT
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Zip | 06473-3926
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | IRENE B BOSCO
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Credential | LCSW
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Telephone | 475-238-8229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 002047
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 006991
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License Number State | CT
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