| Our Community Counseling Llc | |
|
30 Hazel Ter Ste J Woodbridge CT 06525-2240 | |
| (203) 787-8812 | |
| (203) 367-7721 |
| Full Name | Our Community Counseling Llc |
|---|---|
| Speciality | Social Worker |
| Location | 30 Hazel Ter Ste J, Woodbridge, Connecticut |
| Authorized Official Name and Position | Shamar J Young (OWNER) |
| Authorized Official Contact | 2037878812 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Our Community Counseling Llc Po Box 3301 New Haven CT 06515-0401 Ph: (203) 787-8812 | Our Community Counseling Llc 30 Hazel Ter Ste J Woodbridge CT 06525-2240 Ph: (203) 787-8812 |
| NPI Number | 1235668096 |
|---|---|
| Provider Enumeration Date | 06/06/2017 |
| Last Update Date | 05/21/2019 |
| Medicare PECOS PAC ID | 5991136079 |
|---|---|
| Medicare Enrollment ID | O20200505000299 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235668096 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| Provider Name | Shamar Young |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760732085 PECOS PAC ID: 8325479405 Enrollment ID: I20200505000463 |
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