Healthcare Provider Details

I. General information

NPI: 1700089257
Provider Name (Legal Business Name): CLIFFORD BEERS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 JAMES ST
NEW HAVEN CT
06513-3089
US

IV. Provider business mailing address

249 THORNTON ST
HAMDEN CT
06517-1325
US

V. Phone/Fax

Practice location:
  • Phone: 203-777-8648
  • Fax:
Mailing address:
  • Phone: 203-230-5823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number000689
License Number StateCT

VIII. Authorized Official

Name: MS. MARTHA LUCIA PLAZAS
Title or Position: PSYCHOTHERAPIST
Credential: LMFT
Phone: 203-777-8648