Healthcare Provider Details

I. General information

NPI: 1295854776
Provider Name (Legal Business Name): ST. VINCENT'S SPECIAL NEEDS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 MERRITT BLVD
TRUMBULL CT
06611-5435
US

IV. Provider business mailing address

95 MERRITT BLVD
TRUMBULL CT
06611-5435
US

V. Phone/Fax

Practice location:
  • Phone: 203-375-6400
  • Fax: 203-380-1190
Mailing address:
  • Phone: 203-375-6400
  • Fax: 203-380-1190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA3000X
TaxonomyAugmentative Communication Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYMOND G BALDWIN JR.
Title or Position: PRESIDENT CEO
Credential:
Phone: 203-375-6400