Provider Demographics
NPI:1578008744
Name:BROADVIEW COUNSELING & ASSESSMENT, LLC
Entity type:Organization
Organization Name:BROADVIEW COUNSELING & ASSESSMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRANE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, 6TH YR, LPC
Authorized Official - Phone:860-965-7743
Mailing Address - Street 1:426 TAULMAN RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3016
Mailing Address - Country:US
Mailing Address - Phone:860-965-7743
Mailing Address - Fax:
Practice Address - Street 1:243 BROAD ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460
Practice Address - Country:US
Practice Address - Phone:203-850-7709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-27
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002282101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty