College Street Counseling Center LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

004228 Issued in CT

Legal business name

COLLEGE STREET COUNSELING CENTER LLC

Practice address

154 College St
Middletown, CT 06457-3201

Phone

(860) 347-8894

Fax

(860) 346-2405

NPI assigned

Feb 23, 2012

Last updated

Feb 23, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Phillip Sylvester, PH.D.

Title

Partner

Phone

(860) 347-8894

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kathleen Watanabe, LCSW LADC

  • Addiction (Substance Use Disorder) Counselor
  • Middletown, CT
  • NPI 1518079730
  Medicare reassignment
• Sally F Baumer, L.C.S.W.

  • Clinical Social Worker
  • Middletown, CT
  • NPI 1275685331
  NPD (past)
• Rosemary Bleyer, PH.D.

  • Clinical Psychologist
  • Middletown, CT
  • NPI 1821166802
  NPD (past)
• Edward George Langford II, LPC

  • Professional Counselor
  • Middletown, CT
  • NPI 1205303112
  NPD (past)
• Patrick Joseph Russolillo, PH.D

  • Clinical Child & Adolescent Psychologist
  • Middletown, CT
  • NPI 1366593477
  NPD (past)
• Michele Alice St. Marie, MSW

  • Clinical Social Worker
  • Ocean, NJ
  • NPI 1063602381
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1329955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329955200000",
    "number": "1093089948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "154 COLLEGE ST",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064573201",
            "telephone_number": "860-347-8894",
            "fax_number": "860-346-2405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "154 COLLEGE ST",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064573201",
            "telephone_number": "860-347-8894",
            "fax_number": "860-346-2405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLEGE STREET COUNSELING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-23",
        "last_updated": "2012-02-23",
        "status": "A",
        "authorized_official_last_name": "SYLVESTER",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "860-347-8894",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CT",
            "license": "000329",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "004228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Middletown, CT
• Providers in Middletown, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.