Healthcare Provider Details

I. General information

NPI: 1467504779
Provider Name (Legal Business Name): MCCALL FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 N MAIN ST
WINSTED CT
06098-1245
US

IV. Provider business mailing address

PO BOX 806
TORRINGTON CT
06790-0806
US

V. Phone/Fax

Practice location:
  • Phone: 860-496-2100
  • Fax: 860-496-2111
Mailing address:
  • Phone: 860-496-2100
  • Fax: 860-496-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number0544
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number0451
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberC-0248
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHDT-0024
License Number StateCT
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberSA-0071
License Number StateCT

VIII. Authorized Official

Name: MRS. MARIA COUTANT SKINNER
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 860-496-2100