MEDICARE: PARTNERS IN COUNSELING LLC

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	003025	CT
2	1041C0700X	Clinical Social Worker	003025	CT
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	000055	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316197965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARTNERS IN COUNSELING LLC

Provider Business Mailing Address
First Line	:	387 TUCKIE RD
Second Line	:	SUITE D
City	:	NORTH WINDHAM
State	:	CT
Zip	:	06256-1355
Country	:	US
Telephone Number	:	860-423-4279
Fax Number	:	860-423-4284

Provider Business Practice Location Address
First Line	:	387 TUCKIE RD
Second Line	:	SUITE D
City	:	NORTH WINDHAM
State	:	CT
Zip	:	06256-1355
Country	:	US
Telephone Number	:	860-423-4279
Fax Number	:	860-423-4284

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. MARIANNE R. CARROLL
Credential	:	MA,LADC
Telephone Number	:	860-423-4279

Provider Enumeration Date	:	09/19/2008
Last Update Date	:	10/05/2014

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Directions to “PARTNERS IN COUNSELING LLC ” Practice Location

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