Healthcare Provider Details

I. General information

NPI: 1831243047
Provider Name (Legal Business Name): PSYCHOTHERAPY CENTER FOR CHILDREN ADULTS AND FAMILIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 CHERRY ST
MILFORD CT
06460-3555
US

IV. Provider business mailing address

204 CHERRY ST
MILFORD CT
06460-3555
US

V. Phone/Fax

Practice location:
  • Phone: 203-876-0545
  • Fax: 203-876-0814
Mailing address:
  • Phone: 203-876-0545
  • Fax: 203-876-0814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number001868
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00283
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002441
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number001370
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number00815
License Number StateCT
# 7
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number022757
License Number StateCT
# 8
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number022757
License Number StateCT

VIII. Authorized Official

Name: CAROL HUGHES
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 203-874-2660