Healthcare Provider Details

I. General information

NPI: 1043362429
Provider Name (Legal Business Name): MCCALL FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 HIGH ST
TORRINGTON CT
06790-5106
US

IV. Provider business mailing address

58 HIGH ST P.O. BOX 806
TORRINGTON CT
06790-5106
US

V. Phone/Fax

Practice location:
  • Phone: 860-496-2100
  • Fax: 860-496-2111
Mailing address:
  • Phone: 860-496-2100
  • Fax: 860-496-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberSA-0127
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberMHDT-0025
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberSA-0031
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberC-0245
License Number StateCT

VIII. Authorized Official

Name: MRS. MARIA COUTANT SKINNER
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 860-496-2100