Healthcare Provider Details

I. General information

NPI: 1518914746
Provider Name (Legal Business Name): SOUTHINGTON BEHAVIORAL HEALTH CENTER FOR CHILDREN AND FAMILIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 OLD TURNPIKE RD
SOUTHINGTON CT
06489-3633
US

IV. Provider business mailing address

41 OLD TURNPIKE RD
SOUTHINGTON CT
06489-3633
US

V. Phone/Fax

Practice location:
  • Phone: 860-276-9295
  • Fax: 860-276-9296
Mailing address:
  • Phone: 860-276-9295
  • Fax: 860-276-9296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number035132
License Number StateCT

VIII. Authorized Official

Name: SIRIA CON
Title or Position: OFFICE MGR
Credential:
Phone: 860-276-9295