Healthcare Provider Details

I. General information

NPI: 1639177926
Provider Name (Legal Business Name): EASTER SEALS CAPITAL REGION & EASTERN CONNECTICUT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DEERFIELD RD
WINDSOR CT
06095-4252
US

IV. Provider business mailing address

100 DEERFIELD RD
WINDSOR CT
06095-4252
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-9500
  • Fax: 860-714-8555
Mailing address:
  • Phone: 860-714-9500
  • Fax: 860-714-8979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number074502
License Number StateCT

VIII. Authorized Official

Name: ROBIN SHARP
Title or Position: PRESIDENT & CEO
Credential:
Phone: 860-270-0600