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General NPI Number Information
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NPI Number | 1285040675
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Entity Type | Organization
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Legal Business Name | AUTHENTIC RECOVERY, LLC
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Dates
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Enumeration Date | 07/07/2014
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | 1 CARRIAGE PL SUITE 4
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City | WATERBURY
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State | CT
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Zip | 06702-2108
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Country | US
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Telephone | 860-805-2267
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Fax |
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Provider Business Mailing Address
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Address Line | 37 SAW MILL RD
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City | LITCHFIELD
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State | CT
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Zip | 06759-2001
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Country | US
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Telephone | 860-805-2267
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JOHN W SIMONCELLI
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Credential | L.A.D.C., M.S.W.
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Telephone | 860-805-2267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #5
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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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Taxonomy #6
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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