Healthcare Provider Details

I. General information

NPI: 1598844714
Provider Name (Legal Business Name): FAMILY RESOURCE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 MAIN ST
STRATFORD CT
06614
US

IV. Provider business mailing address

3300 MAIN ST
STRATFORD CT
06614
US

V. Phone/Fax

Practice location:
  • Phone: 203-378-4514
  • Fax: 203-378-0443
Mailing address:
  • Phone: 203-378-4514
  • Fax: 203-378-0443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number0309
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberC-0209
License Number StateCT

VIII. Authorized Official

Name: DR. KATHLEEN E MYERS
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 203-378-4514