Organization
COS COB COUNSELING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY M SULLIVAN LCSW (CLINICAL SOCIAL WORKER)
(203) 962-2209
Entity
Organization
Contact information
Practice address
132 E PUTNAM AVE, SUITE H, COS COB, CT 06807-2744
(203) 962-2209
(203) 962-2209
Mailing address
132 E PUTNAM AVE, SUITE H, COS COB, CT 06807-2744
(203) 962-2209
(203) 962-2209
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
005814
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11707654
CAQH
CT
Enumeration date
09/06/2011
Last updated
02/07/2014
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