1437774478 NPI number — ELEVATE COUNSELING FOR CHILDREN AND FAMILIES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437774478 NPI number — ELEVATE COUNSELING FOR CHILDREN AND FAMILIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELEVATE COUNSELING FOR CHILDREN AND FAMILIES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437774478
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 DOGWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WETHERSFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06109-1420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-848-8134
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
156 NEW BRITAIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKY HILL
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06067-5100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-255-4069
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2020

Additional Information

Authorized Official

Authorized Official Last Name:
MACGOVERN
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
Authorized Official Title or Position:
LPC
Authorized Official Telephone Number:
631-848-8134

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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