Healthcare Provider Details

I. General information

NPI: 1346015047
Provider Name (Legal Business Name): CHILD AND FAMILY AGENCY OF SOUTHEASTERN CONNECTICUT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2023
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 W VINE ST
PAWCATUCK CT
06379-1521
US

IV. Provider business mailing address

PO BOX 120
NEW LONDON CT
06320-0120
US

V. Phone/Fax

Practice location:
  • Phone: 860-437-4550
  • Fax: 860-661-4262
Mailing address:
  • Phone: 860-437-4550
  • Fax: 860-661-4262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISA BAXTER
Title or Position: CFAO
Credential:
Phone: 860-443-2896