Provider Demographics
NPI:1730402041
Name:WESTPORT FAMILY COUNSELING
Entity type:Organization
Organization Name:WESTPORT FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:STROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-227-4555
Mailing Address - Street 1:250 POST ROAD EAST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-3616
Mailing Address - Country:US
Mailing Address - Phone:203-227-4555
Mailing Address - Fax:203-227-4855
Practice Address - Street 1:250 POST RD E
Practice Address - Street 2:SUITE 106
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3616
Practice Address - Country:US
Practice Address - Phone:203-227-4555
Practice Address - Fax:203-227-4855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007234101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty