=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538871488
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GREGORY M HROSTEK LPCA, NCC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2022
-----------------------------------------------------
Last Update Date | 01/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350 GROVERS AVE UNIT 6A
-----------------------------------------------------
City | BRIDGEPORT
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06605-3438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-515-5185
-----------------------------------------------------
Fax | 802-497-2187
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 191 QUAKER FARMS RD
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06478-1760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-583-6353
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 46.005111-ASOC
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------