Healthcare Provider Details

I. General information

NPI: 1457823692
Provider Name (Legal Business Name): MENTAL HEALTH AND SUBSTANCE ABUSE ASSOCIATION OF GREATER HARTFORD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2018
Last Update Date: 12/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 E CENTER ST
MANCHESTER CT
06040-4472
US

IV. Provider business mailing address

357 E CENTER ST
MANCHESTER CT
06040-4472
US

V. Phone/Fax

Practice location:
  • Phone: 860-819-8954
  • Fax:
Mailing address:
  • Phone: 860-819-8954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: SAMUEL TWUMASI
Title or Position: MANAGER
Credential:
Phone: 860-819-8954