MEDICARE: SPECIALIZED TREATMENT SERVICES, 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1689225849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALIZED TREATMENT SERVICES, LLC

Provider Business Mailing Address
First Line	:	1000 BRIDGEPORT AVE STE 101
Second Line	:
City	:	SHELTON
State	:	CT
Zip	:	06484-4660
Country	:	US
Telephone Number	:	203-929-2400
Fax Number	:	203-929-5202

Provider Business Practice Location Address
First Line	:	1000 BRIDGEPORT AVE STE 101
Second Line	:
City	:	SHELTON
State	:	CT
Zip	:	06484-4660
Country	:	US
Telephone Number	:	203-929-2400
Fax Number	:	203-929-5202

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	ELIZA BORECKA
Credential	:	LCSW
Telephone Number	:	203-929-2400

Provider Enumeration Date	:	09/27/2019
Last Update Date	:	10/04/2019

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