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General NPI Number Information
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NPI Number | 1578008744
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Entity Type | Organization
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Legal Business Name | BROADVIEW COUNSELING & ASSESSMENT, LLC
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Dates
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Enumeration Date | 12/27/2016
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Last Update Date | 08/13/2018
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Provider Practice Location Address
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Address Line | 243 BROAD ST
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City | MILFORD
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State | CT
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Zip | 06460
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Country | US
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Telephone | 203-850-7709
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Fax |
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Provider Business Mailing Address
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Address Line | 426 TAULMAN RD
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City | ORANGE
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State | CT
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Zip | 06477-3016
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Country | US
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Telephone | 860-965-7743
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL L CRANE
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Credential | MA, 6TH YR, LPC
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Telephone | 860-965-7743
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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 | 002282
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License Number State | CT
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