Healthcare Provider Details

I. General information

NPI: 1750650255
Provider Name (Legal Business Name): MIDWESTERN CONNECTICUT COUNCIL ON ALCOHOLISM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2011
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 BRIDGE ST
NEW MILFORD CT
06776-3547
US

IV. Provider business mailing address

38 OLD RIDGEBURY RD
DANBURY CT
06810-5128
US

V. Phone/Fax

Practice location:
  • Phone: 860-355-7312
  • Fax: 860-354-7023
Mailing address:
  • Phone: 203-792-4515
  • Fax: 203-748-2604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberSA-0215
License Number StateCT

VIII. Authorized Official

Name: MR. LOUIS E VELOTTI
Title or Position: COUNSELOR III
Credential: LADC
Phone: 203-792-4515