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General NPI Number Information
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NPI Number | 1265846778
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Entity Type | Organization
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Legal Business Name | BOURGEOIS LLC
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Dates
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Enumeration Date | 06/12/2014
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Last Update Date | 06/12/2014
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Provider Practice Location Address
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Address Line | 43 SHERMAN HILL RD CORNERSTONE PROFESSIONAL PARK, BUILDING D
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City | WOODBURY
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State | CT
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Zip | 06798-3651
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Country | US
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Telephone | 203-770-1414
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Fax |
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Provider Business Mailing Address
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Address Line | 270 MAIN ST S
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City | WOODBURY
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State | CT
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Zip | 06798-3407
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Country | US
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Telephone | 203-725-5042
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. BARBARA L BOURGEOIS
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Credential | LPC
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Telephone | 203-770-1414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 002514
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License Number State | CT
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