Healthcare Provider Details

I. General information

NPI: 1932630928
Provider Name (Legal Business Name): FAMILY & CHILDREN'S AID
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 WEST ST
DANBURY CT
06810-6528
US

IV. Provider business mailing address

75 WEST ST
DANBURY CT
06810-6528
US

V. Phone/Fax

Practice location:
  • Phone: 203-748-5689
  • Fax: 203-790-8183
Mailing address:
  • Phone: 203-748-5689
  • Fax: 203-790-8183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. IRVIN R JENNINGS
Title or Position: EXECUTIVE AND MEDICAL DIRECTOR
Credential: M.D.
Phone: 203-748-5689