1710480132 NPI number — CONTEMPORARY CARE COUNSELING

Table of content: (NPI 1710480132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710480132 NPI number — CONTEMPORARY CARE COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONTEMPORARY CARE COUNSELING
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:
1710480132
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
84 HOSPITAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06810-6047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-792-0400
Provider Business Mailing Address Fax Number:
203-792-0400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
81 HOLLY HILL LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWICH
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06830-6071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-321-5063
Provider Business Practice Location Address Fax Number:
203-769-1313
Provider Enumeration Date:
03/12/2018

Additional Information

Authorized Official

Authorized Official Last Name:
PERERA
Authorized Official First Name:
TRIQUE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
203-952-2919

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  039232 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1366971855 . This is a "NATIONAL PROVIDER IDENTIFICATION" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1730195751 . This is a "NATIONAL PROVIDER IDENTIFICATION" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1891159331 . This is a "NATIONAL PROVIDER IDENTIFICATION" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1912269333 . This is a "NATIONAL PROVIDER IDENTIFICATION" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1659570281 . This is a "NATIONAL PROVIDER IDENTIFICATION" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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