AUTHENTIC RECOVERY, LLC (NPI# 1285040675) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285040675 |
| Entity Type | Organization |
| Organization Name | AUTHENTIC RECOVERY, LLC |
| Practice Address |
1 Carriage Pl Suite 4 Waterbury CT 06702-2108 |
| Mailing Address |
37 Saw Mill Rd Litchfield CT 06759-2001 |
| Practice Telephone | 8608052267 |
| Mailing Telephone | 8608052267 |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2015-01-12 |
| Authorized Official Name | MR. JOHN W SIMONCELLI (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 8608052267 |
| Authorized Official Credential | L.A.D.C., M.S.W. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| N | 101YP2500X |
Counselor Specialization: Professional |
Behavioral Health & Social Service Providers | ||
| N | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| N | 104100000X | Social Worker | Behavioral Health & Social Service Providers | ||
| Y | 101Y00000X | Counselor | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | 008047242 | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | Authentic Recovery, LLC | 1 Carriage Place, Waterbury, CT 06702 |
| Street Address |
1 CARRIAGE PL SUITE 4 |
| City | WATERBURY |
| State | CT |
| Zip Code | 06702-2108 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649558685 | Kimberly Bella Montefusco | Counselor | 1 Carriage Pl, Suite 4, Waterbury, CT 06702-2108 | 2011-07-25 |
| 1275008575 | Joanna Grace Szymanski | Counselor | 1 Carriage Pl, Waterbury, CT 06702-2108 | 2018-10-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780120295 | Melitza Velez | Counselor | 80 Prospect St., Waterbury, CT 06702 | 2017-01-09 |
| 1467813600 | Ashley Joseph | Counselor | 30 Holmes Ave, Waterbury, CT 06702 | 2016-03-16 |
| 1649662313 | Lori Arens | Social Worker | 141 E Main St Fl 4, Waterbury, CT 06702 | 2015-03-04 |
| 1265725584 | Zelda Shleifer | Audiologist | 21 W Main St Fl Place-3, Waterbury, CT 06702 | 2011-05-19 |
| 1700024585 | Charlene Angela Jurgaitis | Durable Medical Equipment & Medical Supplies | 102 Grand Street, Waterbury, CT 06702 | 2009-02-02 |
| 1518090570 | Nathan Z Imre | Pharmacist | 161 East Main St Central Pharmacy, Waterbury, CT 06702 | 2007-03-13 |
| 1922149467 | Rachael A Petitti | Social Worker | 402 East Main Street, Waterbury, CT 06702 | 2007-02-09 |
| 1710024484 | Abbot Terrace Health Center | Assisted Living Facility | 44 Abbott Terrace, Waterbury, CT 06702 | 2007-01-31 |
| 1205994555 | Michael Arcangel Padilla | Social Worker | Western Connecticut Mental Health Network, 55 West Main Street Suite 410, Waterbury, CT 06702 | 2006-12-05 |
| 1205902723 | Colette M Anderson | Social Worker | 55 West Main St Suite 410, Western Connecticut Mental Health Network, Waterbury, CT 06702 | 2006-11-27 |
| Find all providers in zip 06702 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356968903 | Daihany Mejia-bonilla | Counselor | 84 Buckland Dr, Waterbury, CT 06704-1116 | 2020-06-30 |
| 1962959437 | Kenneth Howard | Counselor | 402 E Main Street, Ipv Fair Unit-waterbury Op Services, Waterbury, CT 06702-1701 | 2016-09-01 |
| 1518217835 | Joy Brundage | Counselor | 160 Midland Rd, Waterbury, CT 06705-3415 | 2012-09-13 |
| 1851661623 | Juliette Lace Hodge | Counselor | 160 Midlan Road, Wellmore, Inc-paladin House, Waterbury, CT 06705-3415 | 2012-01-10 |
| 1457976011 | Jesse Montalvo | Counselor | 141 E Main St, Waterbury, CT 06702-2310 | 2020-06-10 |
| 1477189660 | Kyle L Akeley | Counselor | 50 Brookside Rd, Waterbury, CT 06708-1402 | 2020-03-19 |
| 1548894801 | Virginia Williams | Counselor | 141 E Main St, Waterbury, CT 06702-2310 | 2020-02-26 |
| 1699313593 | Kristen Birmingham | Counselor | 276 Highland Ave, Waterbury, CT 06708-3022 | 2019-12-11 |
| 1881241529 | Gretchen Hale | Counselor | 402 E Main St, Waterbury, CT 06702-1701 | 2019-08-19 |
| 1053971531 | Brianna Doran | Counselor | 141 E Main St, Waterbury, CT 06702-2310 | 2019-06-18 |
| Find all providers in WATERBURY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.