Active NPI
Elaine A Poulos, LPC
- Professional Counselor
- Waterbury, CT
National Provider Identifier
1124000690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 000721
- Practice address
- 64 Robbins St
Crisis Intervention Center
Waterbury, CT 06708-2613 - Phone
- (203) 573-6500
- Fax
- (203) 573-6792
- NPI assigned
- Nov 18, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 000721 | CT | Primary |
Addresses
Primary practice location
64 Robbins St
Crisis Intervention Center
Waterbury, CT 06708-2613
Mailing address
22 Burnham St
Plainville, CT 06062-1702
Phone (860) 747-2997
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000721 | CT | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1124000690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 BURNHAM ST",
"city": "PLAINVILLE",
"state": "CT",
"postal_code": "060621702",
"telephone_number": "860-747-2997"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "64 ROBBINS ST",
"address_2": "CRISIS INTERVENTION CENTER",
"city": "WATERBURY",
"state": "CT",
"postal_code": "067082613",
"telephone_number": "203-573-6500",
"fax_number": "203-573-6792"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POULOS",
"first_name": "ELAINE",
"middle_name": "A",
"name_prefix": "Ms.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-18",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CT",
"license": "000721",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waterbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.