Healthcare Provider Details

I. General information

NPI: 1346550977
Provider Name (Legal Business Name): NEW ENGLAND CENTER FOR C.B.T. & PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2010
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 NATIONAL DR
GLASTONBURY CT
06033-4371
US

IV. Provider business mailing address

110 NATIONAL DR
GLASTONBURY CT
06033-4371
US

V. Phone/Fax

Practice location:
  • Phone: 860-430-5515
  • Fax: 860-430-9754
Mailing address:
  • Phone: 860-430-5515
  • Fax: 860-430-9754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number001420
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number001420
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number001420
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001420
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number001420
License Number StateCT
# 6
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number001420
License Number StateCT

VIII. Authorized Official

Name: MR. THOMAS ANDREW CORDIER
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD LCPC
Phone: 860-430-5515