Boroski, Mark R
Boroski, Mark R is an individual health care provider with primary practice located at 400 Columbus Avenue Adult Psychiatric Clinic, New Haven CT 06519-1233. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Marriage & Family Therapist. Behavioral Health & Social Service Providers / Marriage & Family Therapist is his primary health care specialty. Boroski, Mark R can be contacted via phone (203) 503-3075.Contact Information
Primary practice address
400 Columbus Avenue Adult Psychiatric Clinic
New Haven CT 06519-1233
Phone: (203) 503-3075
Fax: (203) 503-3296
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | 1194 | Connecticut |
| Behavioral Health & Social Service Providers / Marriage & Family Therapist | 106H00000X | 1951 | Connecticut |
Profile Details
| NPI number | 1841672821 |
|---|---|
| LBN Legal business name | Boroski, Mark R |
| Credentials | LMFT,LADC, MA,BS |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 25th, 2015 |
| Last updated | Mar 17th, 2018 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1841672821 | NPPES |
| Connecticut | MEDICAID | 008065074 | |
| Connecticut | Other | 060669107 | |
| Connecticut | Other | NOT ELIGIBLE | |
| Connecticut | Other | NOT ELIGIBLE | |
| Connecticut | Other | 060669107 | |
| Connecticut | Other | 060669107 | |
| Connecticut | Other | CAC-6129 | |
| Connecticut | Other | 060669107 | |
| Connecticut | Other | 10450310 402 E MAIN | |
| Connecticut | Other | 060669107 | |
| Connecticut | Other | NOT ELIGIBLE | |
| Connecticut | Other | ICADC-6129 | |
| Connecticut | Other | 060669107 | |
| Connecticut | Other | 13823195 | |
| Connecticut | Other | PENDING |
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