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General NPI Number Information
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NPI Number | 1174188973
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Entity Type | Organization
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Legal Business Name | C.B.R.T.,LLC
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Dates
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Enumeration Date | 05/07/2019
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Last Update Date | 05/07/2019
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Provider Practice Location Address
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Address Line | 281 HARTFORD TPKE STE 312
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City | VERNON
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State | CT
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Zip | 06066-4707
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Country | US
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Telephone | 860-390-1403
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Fax |
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Provider Business Mailing Address
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Address Line | 111 FARMBROOK LN
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-2887
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Country | US
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Telephone | 860-390-1403
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | KAREN MACKINNON-SAMUELS
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Credential |
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Telephone | 860-402-2437
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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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