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Individual
MARK R BOROSKI
Active
Individual
MARK R BOROSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMFT,LADC, MA,BS
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1194
CT
106H00000X
Marriage & Family Therapist
Primary
1951
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008065074
—
CT
01
—
060669107
HEALTHYCT WELLMORE GRP/FACILITY
CT
01
—
10450310 402 E MAIN
BEACON HEALTH STRATEGIES
CT
01
—
13823195
CAQH
CT
01
—
CAC-6129
CCB-CERTIFIED ADDICTION COUNSELOR
CT
01
—
ICADC-6129
CCB- INTERNATIONALLY CERTIFIED ADDICTION COUNSELOR
CT
01
—
NOT ELIGIBLE
MHN TRICARENORTH
CT
01
—
PENDING
AETNA BEHAVIORAL HEALTH
CT
Enumeration date
06/25/2015
Last updated
03/17/2018
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