Healthcare Provider Details

I. General information

NPI: 1093041220
Provider Name (Legal Business Name): CONNECTICUT THERAPY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2009
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 TITUS RD
WASHINGTON DEPOT CT
06794-1517
US

IV. Provider business mailing address

PO BOX 560
WASHINGTON DEPOT CT
06794-0560
US

V. Phone/Fax

Practice location:
  • Phone: 860-868-0857
  • Fax: 860-868-1288
Mailing address:
  • Phone: 860-868-0857
  • Fax: 860-868-1288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCT

VIII. Authorized Official

Name: GEORGIA G HYNES
Title or Position: COMPANY MANAGER
Credential: CCDP, MATS, CAC, CCS
Phone: 860-868-0857