Healthcare Provider Details

I. General information

NPI: 1215271705
Provider Name (Legal Business Name): THE CHILDREN'S CENTER OF HAMDEN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2012
Last Update Date: 11/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 WHITNEY AVE
HAMDEN CT
06517-2459
US

IV. Provider business mailing address

1400 WHITNEY AVE
HAMDEN CT
06517-2459
US

V. Phone/Fax

Practice location:
  • Phone: 203-248-2116
  • Fax: 202-248-9339
Mailing address:
  • Phone: 203-248-2116
  • Fax: 202-248-9339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number001596
License Number StateCT

VIII. Authorized Official

Name: MR. DANIEL JOHN LYGA
Title or Position: CHIEF OPERATING OFFICER
Credential: L.C.S.W.
Phone: 203-248-2116