Healthcare Provider Details

I. General information

NPI: 1831314970
Provider Name (Legal Business Name): CATHOLIC CHARITIES OF FAIRFIELD COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 JEWETT AVE
BRIDGEPORT CT
06606-2845
US

IV. Provider business mailing address

238 JEWETT AVE
BRIDGEPORT CT
06606-2845
US

V. Phone/Fax

Practice location:
  • Phone: 203-416-1318
  • Fax: 203-373-0835
Mailing address:
  • Phone: 203-416-1318
  • Fax: 203-373-0835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AL BARBER
Title or Position: PRESIDENT & CHIEF OPERATING OFFICER
Credential:
Phone: 203-416-1307