MEDICARE: GIRARD COUNSELING SERVICES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	1206	CT
2	251S00000X	Community/Behavioral Health Agency
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	1206	CT

General Provider Information

NPI Number	:	1063908507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIRARD COUNSELING SERVICES, PLLC

Provider Business Mailing Address
First Line	:	405 BIOSKI RD
Second Line	:
City	:	MIDDLEBURY
State	:	CT
Zip	:	06762-3619
Country	:	US
Telephone Number	:	203-423-3546
Fax Number	:

Provider Business Practice Location Address
First Line	:	182 GRAND ST STE 219
Second Line	:
City	:	WATERBURY
State	:	CT
Zip	:	06702-1914
Country	:	US
Telephone Number	:	203-423-3546
Fax Number	:	203-841-1184

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ROBERT ASHLEY GIRARD II
Credential	:	LMSW, LADC
Telephone Number	:	203-423-3546

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	07/09/2018

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