Breakwater Counseling Center, LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

BREAKWATER COUNSELING CENTER, LLC

Practice address

1110 Broadbridge Ave
Stratford, CT 06615-5801

Phone

(203) 693-1169

NPI assigned

Mar 22, 2018

Organization subpart

No

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

Authorized official

Name

Joanne Martin, LPC

Title

Owner/Counselor

Phone

(203) 693-1169

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1521676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563926400000",
    "number": "1821592072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 BROADBRIDGE AVE",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "066155801",
            "telephone_number": "203-693-1169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 BROADBRIDGE AVE",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "066155801",
            "telephone_number": "203-693-1169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREAKWATER COUNSELING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-22",
        "last_updated": "2019-07-24",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "JOANNE",
        "authorized_official_title_or_position": "OWNER/COUNSELOR",
        "authorized_official_telephone_number": "203-693-1169",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEACON HEALTH",
            "identifier": "CBHP009329",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF CT DPH",
            "identifier": "003183",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2019; 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.