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General NPI Number Information
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NPI Number | 1942605118
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Entity Type | Organization
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Legal Business Name | INTEGRATED BILINGUAL COUNSELING
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Dates
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Enumeration Date | 10/29/2014
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Last Update Date | 09/05/2015
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Provider Practice Location Address
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Address Line | 628 GEORGE ST
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City | NEW HAVEN
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State | CT
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Zip | 06511-5362
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Country | US
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Telephone | 203-767-3607
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Fax |
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Provider Business Mailing Address
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Address Line | 259 3RD AVE
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City | WEST HAVEN
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State | CT
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Zip | 06516-5404
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Country | US
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Telephone | 203-767-3607
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | JOSE F VILLAFUERTE
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Credential | LCSW, LMSW
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Telephone | 203-767-3607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8777
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 8777
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License Number State | CT
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