Healthcare Provider Details

I. General information

NPI: 1366773525
Provider Name (Legal Business Name): NATCHAUG HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 STORRS ROAD
MANSFIELD CENTER CT
06250
US

IV. Provider business mailing address

189 STORRS ROAD
MANSFIELD CENTER CT
06250
US

V. Phone/Fax

Practice location:
  • Phone: 860-696-9920
  • Fax: 860-423-5922
Mailing address:
  • Phone: 860-696-9920
  • Fax: 860-423-5922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number000621
License Number StateCT

VIII. Authorized Official

Name: MRS. SUSAN G WILLIAMS
Title or Position: PRIMARY THERAPIST
Credential: LMFT
Phone: 860-456-1311