Change Counseling, LLC
Organization Active NPI Clinical Social Worker · Willimantic, CT
NPI 1780141465 · NPPES record last updated Feb 28, 2019
Key facts
- NPI
- 1780141465
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Social Worker 1041C0700X
- Legal business name
- CHANGE COUNSELING, LLC
- Practice address
- 750R Main St
Willimantic, CT 06226-2504 - Phone
- (860) 833-2657
- NPI assigned
- Feb 28, 2019
- Organization subpart
- No
Authorized official
- Name
- Madelyn Briggs
- Title
- Owner
- Phone
- (860) 833-2657
Practitioners 14
-
Rachel Ann Hence, MSW
-
Cheryl L Jacques, APRN
-
Madelyn Straub, LCSW
-
Gary Alan Palardy, APRN
-
Melanie Grieco, LCSW
-
Angela Hutchins, LMSW
-
Jean-Luc Poulard, LMSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200127000687 | CT | Part B Supplier - Clinic/Group Practice | 9234564956 |
Receives reassigned benefits from 10 practitioners Practice locations: Mansfield Center, CT; Niantic, CT; Putnam, CT; Woodstock Valley, CT |
National Provider Directory
Locations
6 Ledgebrook Dr
Ste C
Mansfield Center, CT 06250
Phone (860) 833-2657
134 Main St
Putnam, CT 06260
Phone (860) 245-1107
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker |
1041C0700X | Yes |
Addresses
Primary practice location
750R Main St
Willimantic, CT 06226-2504
Mailing address
261 Church St
Willimantic, CT 06226-2625
Phone (860) 833-2657
Other providers in Willimantic, CT
- Eliuteria L Castro
- Cheryl A Ceniglio
- Center for Mental Wellness PLLC
- Centra Home-Care Services LLC
- Lisa T Chadwick
- Julia Charpentier
- Jamie Elizabeth Charron
- Blanca D Charry
- Chelliah Pandian LLC
- Douglas Chung
All providers in Willimantic, 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 Feb 28, 2019. 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.