Healthcare Provider Details

I. General information

NPI: 1588038178
Provider Name (Legal Business Name): BEHAVIORAL HEALTH CONNECTICUT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 COURT ST 8TH FLOOR
MIDDLETOWN CT
06457-3346
US

IV. Provider business mailing address

213 COURT ST 8TH FLOOR
MIDDLETOWN CT
06457-3346
US

V. Phone/Fax

Practice location:
  • Phone: 860-638-5309
  • Fax:
Mailing address:
  • Phone: 860-638-5309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. SAMUEL MOY
Title or Position: PRESIDENT/CEO
Credential: PH.D.
Phone: 860-638-5309