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General NPI Number Information
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NPI Number | 1811906241
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Entity Type | Organization
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Legal Business Name | ADOLESCENT & FAMILY COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 07/07/2008
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Provider Practice Location Address
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Address Line | 350 S MAIN ST THE REPUBLIC BUILDING / SUITE 23
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City | CHESHIRE
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State | CT
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Zip | 06410-3160
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Country | US
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Telephone | 203-271-1234
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Fax | 203-272-9094
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Provider Business Mailing Address
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Address Line | 350 S MAIN ST THE REPUBLIC BUILDING / SUITE 23
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City | CHESHIRE
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State | CT
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Zip | 06410-3160
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Country | US
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Telephone | 203-271-1234
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Fax | 203-272-9094
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. HERBERT JAY ROSENFIELD
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Credential | ACSW, LCSW, BCD
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Telephone | 203-271-1234
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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 |
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | CT
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