Healthcare Provider Details

I. General information

NPI: 1114106143
Provider Name (Legal Business Name): URBAN LEAGUE OF GREATER HARTFORD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 WOODLAND STREET
HARTFORD CT
06105-1210
US

IV. Provider business mailing address

140 WOODLAND STREET
HARTFORD CT
06105-1210
US

V. Phone/Fax

Practice location:
  • Phone: 860-527-0147
  • Fax: 860-293-2621
Mailing address:
  • Phone: 860-527-0147
  • Fax: 860-293-2621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number006110
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number006110
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number006110
License Number StateCT

VIII. Authorized Official

Name: MS. KAREN LEIGH TOCHER
Title or Position: CLINICAL SUPERVISOR
Credential: LCSW
Phone: 860-728-4278