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NPI Code Detail

MEDICARE: CHEMICAL ABUSE SERVICES AGENCY, INC.

MEDICARE: CHEMICAL ABUSE SERVICES AGENCY, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM2800XMethadone ClinicSA- 0120CT
2251S00000XCommunity/Behavioral Health AgencySA-0120CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043421985
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHEMICAL ABUSE SERVICES AGENCY, INC.
Provider Business Mailing Address
First Line : 1124 IRANISTAN AVE
Second Line :
City : BRIDGEPORT
State : CT
Zip : 06605-1121
Country : US
Telephone Number : 203-331-4728
Fax Number : 203-873-0987
Provider Business Practice Location Address
First Line : 426 EAST ST
Second Line :
City : NEW HAVEN
State : CT
Zip : 06511-5018
Country : US
Telephone Number : 203-495-7710
Fax Number : 203-495-7713
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. ASHER DELERME
Credential : MS, LADC, CCS, CCDP
Telephone Number : 203-331-4728
Provider Enumeration Date : 05/24/2007
Last Update Date : 03/22/2013

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