Baxley Counseling LLC
Organization Active NPI Clinical Social Worker · Ledyard, CT
NPI 1629527064 · NPPES record last updated Oct 10, 2016
Key facts
- NPI
- 1629527064
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 006813 (CT)
- Legal business name
- BAXLEY COUNSELING LLC
- Practice address
- 36 Highland Dr
Ledyard, CT 06339-1836 - Phone
- (860) 287-2956
- NPI assigned
- Sep 27, 2016
- Organization subpart
- No
Authorized official
- Name
- Sharon Baxley
- Title
- LCSW
- Phone
- (860) 287-2956
Practitioners 1
-
Sharon Deane Baxley, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161010000230 | CT | Part B Supplier - Clinic/Group Practice | 6608164595 |
Receives reassigned benefits from 1 practitioner Practice locations: Colchester, CT |
National Provider Directory
Locations
79A Norwich Ave
Colchester, CT 06415
Phone (860) 501-6065
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker |
1041C0700X | 006813 | CT | Yes |
Addresses
Primary practice location
36 Highland Dr
Ledyard, CT 06339-1836
Mailing address
36 Highland Dr
Ledyard, CT 06339-1836
Phone (860) 287-2956
Other providers in Ledyard, CT
- Sandra Berardy
- Kenneth Warren Berdeen II
- Marcela Bernal
- Krista Schermerhorn Bordeleau
- Doris Eve Case
All providers in Ledyard, 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 10, 2016. 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.