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General NPI Number Information
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NPI Number | 1104424464
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Entity Type | Organization
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Legal Business Name | CBL II, LLC
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Dates
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Enumeration Date | 10/09/2020
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Last Update Date | 10/09/2020
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Provider Practice Location Address
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Address Line | 163 ROBIN DR
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City | COLLINSVILLE
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State | CT
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Zip | 06019-3730
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Country | US
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Telephone | 860-693-4605
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Fax |
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Provider Business Mailing Address
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Address Line | 163 ROBIN DR
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City | COLLINSVILLE
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State | CT
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Zip | 06019-3730
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Country | US
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Telephone | 860-693-4605
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | CHELI LANGE
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Credential | LPC
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Telephone | 860-335-4545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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