Ethan Emery Bourque
Individual provider Active NPI Counselor · Wilton, CT
NPI 1376321000 · NPPES record last updated Sep 14, 2023
Key facts
- NPI
- 1376321000
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 396 Danbury Rd Ste 2a
Wilton, CT 06897-2024 - Phone
- (203) 202-7654
- NPI assigned
- Sep 14, 2023
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor |
101Y00000X | Yes |
Addresses
Primary practice location
396 Danbury Rd Ste 2a
Wilton, CT 06897-2024
Mailing address
396 Danbury Rd Ste 2a
Wilton, CT 06897-2024
Other providers in Wilton, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 14, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.