Healthcare Provider Details

I. General information

NPI: 1881629434
Provider Name (Legal Business Name): STATE OF CONNECTICUT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 PARK STREET
NEW HAVEN CT
06790
US

IV. Provider business mailing address

34 PARK STREET
NEW HAVEN CT
06790
US

V. Phone/Fax

Practice location:
  • Phone: 203-974-7417
  • Fax: 203-974-7413
Mailing address:
  • Phone: 203-974-7417
  • Fax: 203-974-7413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. CHERYL ARORA
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 860-418-6937