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General NPI Number Information
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NPI Number | 1417711847
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Entity Type | Organization
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Legal Business Name | KERITH BROOK COUNSELING, LLC
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Dates
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Enumeration Date | 02/07/2024
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 9 CODY STREET
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City | WEST HARTFORD
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State | CT
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Zip | 06110
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Country | US
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Telephone | 860-288-7017
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Fax | 860-288-7017
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Provider Business Mailing Address
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Address Line | 9 CODY STREET
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City | WEST HARTFORD
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State | CT
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Zip | 06110
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Country | US
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Telephone | 860-288-7017
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Fax | 860-760-6413
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Authorized Official
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Title or Position | CLINICAL DIRECTOR/OWNER
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Name | PETA LAWSON
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Credential | LPC
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Telephone | 860-288-7017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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