Twin Peaks Counseling, LLC
Organization Active NPI Clinical Social Worker · Derby, CT
NPI 1477065407 · NPPES record last updated Oct 31, 2017
Key facts
- NPI
- 1477065407
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 009421 (CT)
- Legal business name
- TWIN PEAKS COUNSELING, LLC
- Practice address
- 303 Roosevelt Dr
Derby, CT 06418-1629 - Phone
- (475) 777-9303
- NPI assigned
- Oct 31, 2017
- Organization subpart
- No
Authorized official
- Name
- Dayne Bachmann, LCSW
- Title
- Owner/Clinician
- Phone
- (475) 777-9303
Practitioners 5
-
Hannah Kristan, LCSW
-
Dayne Romano, LCSW
-
Daisy Abbott, LCSW
-
Danielle Capozziello, LCSW
-
Teila Marie Lanci, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180424002611 | CT | Part B Supplier - Clinic/Group Practice | 0749543817 |
Receives reassigned benefits from 4 practitioners Practice locations: Woodbridge, CT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker |
1041C0700X | 009421 | CT | Yes |
Addresses
Primary practice location
303 Roosevelt Dr
Derby, CT 06418-1629
Mailing address
303 Roosevelt Dr
Derby, CT 06418-1629
Phone (475) 777-9303
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008064720 | Medicaid | CT |
Other providers in Derby, CT
- Jessica Lauren Thongparn
- Michael William Tichy
- Amy Tinney
- Joanna Torres
- Nicholas John Totalo Jr.
- Two Rivers Counseling, LLC
- Daniel Underhill
- Urgent Care of Derby, LLC
- Rabia Usman
- Vacillate Then Elevate Wellness Center PLLC
All providers in Derby, CT · Clinical Social Worker in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 31, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.