Healthcare Provider Details

I. General information

NPI: 1861624256
Provider Name (Legal Business Name): CATHOLIC CHARITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 WADSWORTH ST
HARTFORD CT
06106-7108
US

IV. Provider business mailing address

45 WADSWORTH ST
HARTFORD CT
06106-7108
US

V. Phone/Fax

Practice location:
  • Phone: 860-527-1124
  • Fax: 860-724-2539
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number101YM0800X
License Number StateCT

VIII. Authorized Official

Name: ROLANDO MARTINEZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 860-527-1124