Healthcare Provider Details

I. General information

NPI: 1114015211
Provider Name (Legal Business Name): NEWTOWN YOUTH AND FAMILY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 BERKSHIRE RD. NEWTOWN YOUTH AND FAMILY SERVICES
SANDY HOOK CT
06482
US

IV. Provider business mailing address

15 BERKSHIRE RD. NEWTOWN YOUTH AND FAMILY SERVICES
SANDY HOOK CT
06482
US

V. Phone/Fax

Practice location:
  • Phone: 203-426-8103
  • Fax: 203-270-4338
Mailing address:
  • Phone: 203-426-8103
  • Fax: 203-270-4338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberOPCC-27
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberC-0254
License Number StateCT

VIII. Authorized Official

Name: CANDICE FOSTER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 203-426-8103