Organization
AUTHENTIC RECOVERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN W SIMONCELLI L.A.D.C., M.S.W. (EXECUTIVE DIRECTOR)
(860) 805-2267
Entity
Organization
Contact information
Practice address
1 CARRIAGE PL, SUITE 4, WATERBURY, CT 06702-2108
(860) 805-2267
Mailing address
37 SAW MILL RD, LITCHFIELD, CT 06759-2001
(860) 805-2267
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008047242
—
CT
Enumeration date
07/07/2014
Last updated
01/12/2015
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