Healthcare Provider Details

I. General information

NPI: 1437540176
Provider Name (Legal Business Name): ANNIE C. COURTNEY FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 SCHRAFFTS DR A5
WATERBURY CT
06705-3222
US

IV. Provider business mailing address

211 SCHRAFFTS DR A5
WATERBURY CT
06705-3222
US

V. Phone/Fax

Practice location:
  • Phone: 475-235-2184
  • Fax:
Mailing address:
  • Phone: 475-235-2184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StateCT

VIII. Authorized Official

Name: SUZAN MURIELLE PLOWMAN
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 475-235-2184