Healthcare Provider Details

I. General information

NPI: 1841551553
Provider Name (Legal Business Name): CATHOLIC CHARITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 GRANDVIEW TER
HARTFORD CT
06114-2209
US

IV. Provider business mailing address

220 GRANDVIEW TER
HARTFORD CT
06114-2209
US

V. Phone/Fax

Practice location:
  • Phone: 860-997-1482
  • Fax:
Mailing address:
  • Phone: 860-997-1482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: SUHAIL RODRIGUEZ
Title or Position: CLINICAL SUPERVISOR
Credential: MS
Phone: 860-692-1002