Healthcare Provider Details

I. General information

NPI: 1851628366
Provider Name (Legal Business Name): CONNECTICUT BEHAVIORAL HEALTH ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 FAIR HARBOUR PL
NEW LONDON CT
06320-4710
US

IV. Provider business mailing address

41 FAIR HARBOUR PL
NEW LONDON CT
06320-4710
US

V. Phone/Fax

Practice location:
  • Phone: 860-437-6914
  • Fax: 860-437-6920
Mailing address:
  • Phone: 860-437-6914
  • Fax: 860-437-6920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ROBERT FOX
Title or Position: CEO
Credential:
Phone: 860-437-6914