Healthcare Provider Details

I. General information

NPI: 1417398041
Provider Name (Legal Business Name): Y-US, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 05/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1477 PARK ST 1ST FLOOR
HARTFORD CT
06106-2235
US

IV. Provider business mailing address

PO BOX 261140
HARTFORD CT
06126-1140
US

V. Phone/Fax

Practice location:
  • Phone: 860-951-7268
  • Fax: 860-951-7269
Mailing address:
  • Phone: 860-951-7268
  • Fax: 860-951-7269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number008119
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS C MICHALSKI JR.
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 860-951-7268