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General NPI Number Information
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NPI Number | 1114106143
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Entity Type | Organization
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Legal Business Name | URBAN LEAGUE OF GREATER HARTFORD
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Dates
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Enumeration Date | 10/26/2007
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Last Update Date | 10/26/2007
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Provider Practice Location Address
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Address Line | 140 WOODLAND STREET
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City | HARTFORD
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State | CT
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Zip | 06105-1210
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Country | US
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Telephone | 860-527-0147
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Fax | 860-293-2621
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Provider Business Mailing Address
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Address Line | 140 WOODLAND STREET
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City | HARTFORD
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State | CT
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Zip | 06105-1210
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Country | US
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Telephone | 860-527-0147
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Fax | 860-293-2621
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Authorized Official
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Title or Position | CLINICAL SUPERVISOR
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Name | MS. KAREN LEIGH TOCHER
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Credential | LCSW
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Telephone | 860-728-4278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 006110
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 006110
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 006110
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License Number State | CT
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