Healthcare Provider Details

I. General information

NPI: 1902921380
Provider Name (Legal Business Name): CORNELL SCOTT HILL HEALTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400-428 COLUMBUS AVENUE
NEW HAVEN CT
06519-1233
US

IV. Provider business mailing address

400 COLUMBUS AVENUE CREDENTIALING SPECIALIST
NEW HAVEN CT
06519-1223
US

V. Phone/Fax

Practice location:
  • Phone: 203-503-3000
  • Fax: 203-503-3224
Mailing address:
  • Phone: 203-503-3174
  • Fax: 203-503-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberSA-0122
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0459
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateCT
# 7
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateCT
# 8
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateCT
# 9
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number0004
License Number StateCT

VIII. Authorized Official

Name: SOL MARIA GONZALEZ
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 203-503-3174