Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CT | |
Y | 101YM0800X | Mental Health Counselor | 5281 | CT |
N | 101YP1600X | Pastoral Counselor | CT |
NPI | 1104584507 |
---|---|
Provider Name | Mr. Eric Anthony Taveras |
First Address | Danbury, CT 06810-2016 |
Second Address | Danbury, CT 06810-2016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2021 |
Last Update Date | 02/12/2021 |