Healthcare Provider Details

I. General information

NPI: 1952855173
Provider Name (Legal Business Name): MIDWESTERN CONNECTICUT COUNCIL OF ALCOHOLISM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 OLD RIDGEBURY RD
DANBURY CT
06810-5128
US

IV. Provider business mailing address

38 OLD RIDGEBURY RD
DANBURY CT
06810-5128
US

V. Phone/Fax

Practice location:
  • Phone: 203-792-4515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TAMMY ROVERO
Title or Position: CENTRAL ADMINISTRATION
Credential:
Phone: 203-792-4515