Eastern Services & Camp Simon, LLC
Organization Active NPI Professional Counselor · East Windsor, CT
NPI 1902173370 · NPPES record last updated Feb 11, 2020
Key facts
- NPI
- 1902173370
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 001470 (CT)
- Legal business name
- EASTERN SERVICES & CAMP SIMON, LLC
- Practice address
- 115 Bridge St
Suite C
East Windsor, CT 06088-9547 - Phone
- (860) 254-5127
- Fax
- (860) 254-5254
- NPI assigned
- Nov 29, 2011
- Organization subpart
- No
Authorized official
- Name
- Maly Phimvongsa, LPC, NCC
- Title
- Director
- Phone
- (860) 254-5127
Corporate family (same tax ID) 1
National Provider Directory
- Tax ID family
- Eastern Services Camp Simon LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor |
101YP2500X | 001470 | CT | Yes |
Addresses
Primary practice location
115 Bridge St
Suite C
East Windsor, CT 06088-9547
Mailing address
115 Bridge St
Suite C
East Windsor, CT 06088-9547
Phone (860) 254-5127
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004257053 | Medicaid | CT |
Other providers in East Windsor, CT
- Joseph Lakshman Dene
- Susan J Devine
- Jonah Earl
- East Windsor Ambulance Assoc
- East Windsor Board of Education
- Effective Solutions Counseling, LLC
- Elegant Clinical Corporation
- Catherine Marie Ewing
- Sydney Ezold
- Stanley Feldman
All providers in East Windsor, CT · Professional Counselor 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 11, 2020. 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.