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General NPI Number Information
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NPI Number | 1700658325
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Entity Type | Organization
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Legal Business Name | COOPERSMITH COUNSELING CENTER LLC
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Dates
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Enumeration Date | 10/26/2023
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 720 HOPMEADOW ST STE 3
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City | SIMSBURY
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State | CT
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Zip | 06070-2224
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Country | US
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Telephone | 203-525-9024
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Fax |
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Provider Business Mailing Address
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Address Line | 720 HOPMEADOW ST STE 3
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City | SIMSBURY
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State | CT
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Zip | 06070-2224
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Country | US
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Telephone | 203-525-9024
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAKE COOPERSMITH
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Credential | LPC
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Telephone | 203-525-9024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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