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General NPI Number Information
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NPI Number | 1093002966
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Entity Type | Organization
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Legal Business Name | FAMILY SERVICES OF EASTERN CONNECTICUT, LLC
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Dates
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Enumeration Date | 06/29/2011
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Last Update Date | 08/20/2018
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Provider Practice Location Address
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Address Line | 428 HARTFORD TPKE SUITE 113
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City | VERNON
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State | CT
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Zip | 06066
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Country | US
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Telephone | 860-268-2086
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Fax |
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Provider Business Mailing Address
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Address Line | 428 HARTFORD TPKE SUITE 113
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City | VERNON
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State | CT
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Zip | 06066-4841
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Country | US
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Telephone | 860-268-2086
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. RICHARD GRIFFITHS
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Credential |
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Telephone | 860-924-0796
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 001081
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License Number State | CT
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