Healthcare Provider Details

I. General information

NPI: 1417774498
Provider Name (Legal Business Name): BETHSAIDA FRANCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 NEW BRITAIN AVE
WEST HARTFORD CT
06110-2440
US

IV. Provider business mailing address

327 CLINTON ST
NEW BRITAIN CT
06053-3596
US

V. Phone/Fax

Practice location:
  • Phone: 860-987-2443
  • Fax:
Mailing address:
  • Phone: 860-987-2443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BETHSAIDA FRANCO
Title or Position: PROFESSIONAL COUNSELOR, OWNER
Credential: LPC
Phone: 860-987-2443