MEDICARE: INTEGRATED BILINGUAL COUNSELING

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	8777	CT
2	251S00000X	Community/Behavioral Health Agency	8777	CT

General Provider Information

NPI Number	:	1942605118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED BILINGUAL COUNSELING

Provider Business Mailing Address
First Line	:	259 3RD AVE
Second Line	:
City	:	WEST HAVEN
State	:	CT
Zip	:	06516-5404
Country	:	US
Telephone Number	:	203-767-3607
Fax Number	:

Provider Business Practice Location Address
First Line	:	628 GEORGE ST
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-5362
Country	:	US
Telephone Number	:	203-767-3607
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER
Name	:	JOSE F VILLAFUERTE
Credential	:	LCSW, LMSW
Telephone Number	:	203-767-3607

Provider Enumeration Date	:	10/29/2014
Last Update Date	:	09/05/2015

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Directions to “INTEGRATED BILINGUAL COUNSELING ” Practice Location

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