Basic Information
| Provider Information | |||||||||
| NPI: | 1154344828 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARTES | ||||||||
| FirstName: | JAMES | ||||||||
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| Credential: | LADC, LCSW, OTRL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 56 FRANKLIN ST | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067061221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037098873 | ||||||||
| FaxNumber: | 2037098689 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 JEFFERSON SQ | ||||||||
| Address2: | |||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067061109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037096200 | ||||||||
| FaxNumber: | 2037093335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 10/20/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 000009 | CT | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 106H00000X | 000875 | CT | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 004253861 | 05 | CT | MEDICAID |