Healthcare Provider Details

I. General information

NPI: 1528499969
Provider Name (Legal Business Name): CONNECTICUT INSTITUTE FOR COMMUNITIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 WEST ST
DANBURY CT
06810-6361
US

IV. Provider business mailing address

120 MAIN ST FL 4
DANBURY CT
06810-7834
US

V. Phone/Fax

Practice location:
  • Phone: 203-791-5005
  • Fax:
Mailing address:
  • Phone: 203-743-9760
  • Fax: 203-743-3411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number0508
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number0508
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number508
License Number StateCT

VIII. Authorized Official

Name: MR. KATHERINE CURRAN
Title or Position: PRESIDENT & CEO
Credential: J.D.
Phone: 203-743-9760