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General NPI Number Information
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NPI Number | 1538342829
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Entity Type | Organization
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Legal Business Name | WALTER VAN SAMBECK
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Dates
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Enumeration Date | 12/10/2007
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 244 S MAIN ST
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City | COLCHESTER
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State | CT
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Zip | 06415-1405
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Country | US
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Telephone | 860-537-3977
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Fax |
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Provider Business Mailing Address
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Address Line | 244 S MAIN ST
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City | COLCHESTER
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State | CT
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Zip | 06415-1405
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Country | US
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Telephone | 860-537-3977
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WALTER JOHANNES VAN SAMBECK
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Credential |
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Telephone | 860-537-3977
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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 | 000493
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | 023879
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 000493
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License Number State | CT
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