Healthcare Provider Details

I. General information

NPI: 1780120063
Provider Name (Legal Business Name): GREATER NEW HAVEN COUNSELING AND FAMILY THERAPY CENTER, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 04/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1844 WHITNEY AVE 2ND FLOOR
HAMDEN CT
06517-1400
US

IV. Provider business mailing address

1844 WHITNEY AVE 2ND FLOOR
HAMDEN CT
06517-1400
US

V. Phone/Fax

Practice location:
  • Phone: 203-407-1310
  • Fax: 203-407-1309
Mailing address:
  • Phone: 203-407-1310
  • Fax: 203-407-1309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number000614
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1845
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5770
License Number StateCT

VIII. Authorized Official

Name: DR. ANTHONY F CAMPAGNA
Title or Position: PARTNER
Credential: PH.D.
Phone: 203-407-1310