NPIMap

Organization Active NPI

Fairfield County Mental Wellness Counseling, LLC

Doing business as Fairfield County Mental Wellness Counseling

  • Professional Counselor
  • Stratford, CT
National Provider Identifier
1265903223
Registry record updated Jan 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
FAIRFIELD COUNTY MENTAL WELLNESS COUNSELING, LLC
Doing business as
Fairfield County Mental Wellness Counseling
Practice address
3241 Main St Ste B
Stratford, CT 06614-4850
Phone
(203) 500-6397
Fax
(203) 383-4499
NPI assigned
Dec 16, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2024

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

Authorized official

Name
Silvia Dicovich, LPCNPI 1225508229
Title
Owner
Phone
(203) 500-6397

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X Primary

Addresses

Primary practice location

3241 Main St Ste B
Stratford, CT 06614-4850

Mailing address

3241 Main St Ste B
Stratford, CT 06614-4850
Phone (203) 500-6397

Other identifiers 1

IdentifierTypeStateIssuer
004069985MedicaidCT

Other names 1

  • Fairfield County Mental Wellness Counseling Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1544918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704931200000",
    "number": "1265903223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3241 MAIN ST STE B",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "066144850",
            "telephone_number": "203-500-6397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3241 MAIN ST STE B",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "066144850",
            "telephone_number": "203-500-6397",
            "fax_number": "203-383-4499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRFIELD COUNTY MENTAL WELLNESS COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-16",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A",
        "authorized_official_last_name": "DICOVICH",
        "authorized_official_first_name": "SILVIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-500-6397",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004069985",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairfield County Mental Wellness Counseling",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fairfield County Mental Wellness Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stratford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.