Healthcare Provider Details

I. General information

NPI: 1871862789
Provider Name (Legal Business Name): LATINO COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MAIN ST FL 3
HARTFORD CT
06106-1890
US

IV. Provider business mailing address

221 MAIN ST FL 3
HARTFORD CT
06106-1890
US

V. Phone/Fax

Practice location:
  • Phone: 860-296-6400
  • Fax: 860-728-3782
Mailing address:
  • Phone: 860-296-6400
  • Fax: 860-728-3782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number177070465
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number087387212
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 8
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateNULL

VIII. Authorized Official

Name: MADELINE RODRIGUEZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 860-296-6400