Healthcare Provider Details

I. General information

NPI: 1104942481
Provider Name (Legal Business Name): CONNECTICUT COUNSELING CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MIDLAND RD
WATERBURY CT
06705-3412
US

IV. Provider business mailing address

4 MIDLAND RD
WATERBURY CT
06705-3412
US

V. Phone/Fax

Practice location:
  • Phone: 203-755-8874
  • Fax: 203-497-9570
Mailing address:
  • Phone: 203-755-8874
  • Fax: 203-497-9570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License NumberSA0200
License Number StateCT

VIII. Authorized Official

Name: MR. RICHARD BILANGI
Title or Position: EXECUTIVE DIRECTOR-PRESIDENT
Credential:
Phone: 203-743-4698