Healthcare Provider Details

I. General information

NPI: 1588954580
Provider Name (Legal Business Name): CENTRAL CONNECTICUT AREA HEALTH EDUCATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20-28 SARGEANT ST
HARTFORD CT
06105-1400
US

IV. Provider business mailing address

20-28 SARGEANT ST
HARTFORD CT
06105-1400
US

V. Phone/Fax

Practice location:
  • Phone: 860-920-5149
  • Fax: 860-920-5136
Mailing address:
  • Phone: 860-920-5149
  • Fax: 860-920-5136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: BRENDA P DELGADO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 860-920-5149