| Organization Name: | COS COB COUNSELING CENTER |
| NPI Number: | 1275814147 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY M SULLIVAN (CLINICAL SOCIAL WORKER) |
| Mailing Address: | 132 E Putnam Ave Suite H Cos Cob |
| State: | CT US |
| Postal Code: | 068072744 |
| Phone Number: | 2039622209 |
| Fax Number: | 2039622209 |
| NPI Enumeration Date: | 09/06/2011 |
| NPI Last Update Date: | 02/07/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 005814 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |