Healthcare Provider Details

I. General information

NPI: 1043220619
Provider Name (Legal Business Name): THE CHILD & FAMILY INSTITUTE OF FAIRFIELD COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 JUNCTION RD
BROOKFIELD CT
06804-3457
US

IV. Provider business mailing address

33 JUNCTION RD
BROOKFIELD CT
06804-3457
US

V. Phone/Fax

Practice location:
  • Phone: 203-740-7296
  • Fax: 203-740-7696
Mailing address:
  • Phone: 203-740-7296
  • Fax: 203-740-7696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: PAMELA SAMAHA
Title or Position: DIRECTOR
Credential: LCSW
Phone: 203-740-7296