Healthcare Provider Details

I. General information

NPI: 1265449359
Provider Name (Legal Business Name): CONNECTICUT RENAISSANCE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 BYINGTON PL
NORWALK CT
06850-3309
US

IV. Provider business mailing address

1 WATERVIEW DR STE 202
SHELTON CT
06484-4368
US

V. Phone/Fax

Practice location:
  • Phone: 203-866-2541
  • Fax: 203-854-5682
Mailing address:
  • Phone: 203-336-5225
  • Fax: 203-336-2851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DAWN PATSTON
Title or Position: COO
Credential: LMFT
Phone: 203-336-5225