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General NPI Number Information
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NPI Number | 1154878619
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Entity Type | Organization
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Legal Business Name | REGIONAL YOUNG MEN'S CHRISTIAN ASSOCIATION OF WESTERN CONNECTICUT, INC
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 241 FEDERAL ROAD UNIT B21
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City | BROOKFIELD
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State | CT
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Zip | 06804
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Country | US
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Telephone | 203-740-3432
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Fax | 203-775-8350
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Provider Business Mailing Address
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Address Line | 241 FEDERAL ROAD UNIT B21
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City | BROOKFIELD
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State | CT
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Zip | 06804
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Country | US
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Telephone | 203-740-3432
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Fax | 203-775-8350
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MARIE MISZEWSKI
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Credential |
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Telephone | 203-740-3432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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