Healthcare Provider Details

I. General information

NPI: 1518985183
Provider Name (Legal Business Name): TOWN OF EAST HAVEN EAST HAVEN COUNSELING AND COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 THOMPSON AVE EAST HAVEN COUNSELING & COMMUNITY SERVICES
EAST HAVEN CT
06512
US

IV. Provider business mailing address

595 THOMPSON AVE EAST HAVEN COUNSELING & COMMUNITY SERVICES
EAST HAVEN CT
06512
US

V. Phone/Fax

Practice location:
  • Phone: 203-468-3297
  • Fax: 203-468-3334
Mailing address:
  • Phone: 203-468-3297
  • Fax: 203-468-3334

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

VIII. Authorized Official

Name: LAWRENCE DOYLE
Title or Position: EXECUTIVE DIRECTOR
Credential: MS LPC
Phone: 203-468-3297