=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629783915
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESTORING LIVES COUNSELING PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2023
-----------------------------------------------------
Last Update Date | 01/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 SCHUMACHER DR
-----------------------------------------------------
City | ANSONIA
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06401-2802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-213-7399
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 SCHUMACHER DR
-----------------------------------------------------
City | ANSONIA
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06401-2802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | BETSY RIVERA RUIZ
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 203-213-7399
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------