Healthcare Provider Details

I. General information

NPI: 1487034641
Provider Name (Legal Business Name): FAMILY STRONG CT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 PETER RD
SOUTHBURY CT
06488-2681
US

IV. Provider business mailing address

49 PETER RD
SOUTHBURY CT
06488-2681
US

V. Phone/Fax

Practice location:
  • Phone: 203-267-4455
  • Fax:
Mailing address:
  • Phone: 203-267-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-12-10033
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SARA BROWN-SURMOLIAN
Title or Position: PRESIDENT
Credential:
Phone: 203-267-4455