=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710033576
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOLUTIONS COUNSELING AND CONSULTATION, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 270 AMITY RD SUITE 220
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06525-2236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-454-6722
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 365956
-----------------------------------------------------
City | HYDE PARK
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02136-0017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-276-3612
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNEROPERATOR-CSW
-----------------------------------------------------
Name | MS. CONNIE BARBARA COHEN
-----------------------------------------------------
Credential | ACSW,LICSW
-----------------------------------------------------
Telephone | 203-454-6722
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 002896
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------