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General NPI Number Information
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NPI Number | 1164580379
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Entity Type | Organization
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Legal Business Name | INTERCOMMUNITY, INC.
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 16 COVENTRY STREET
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City | HARTFORD
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State | CT
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Zip | 06112
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Country | US
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Telephone | 860-714-3701
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Fax | 860-714-8974
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Provider Business Mailing Address
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Address Line | 111 FOUNDERS PLAZA SUITE 1802
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City | EAST HARTFORD
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State | CT
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Zip | 06108
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Country | US
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Telephone | 860-714-3701
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Fax | 860-714-8974
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | KIMBERLY L BEAUREGARD
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Credential | LCSW
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Telephone | 860-291-1340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | SA-0159
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | SA-0201
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License Number State | CT
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