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General NPI Number Information
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NPI Number | 1417398041
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Entity Type | Organization
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Legal Business Name | Y-US, INC.
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Dates
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Enumeration Date | 07/11/2013
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Last Update Date | 05/08/2014
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Provider Practice Location Address
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Address Line | 1477 PARK ST 1ST FLOOR
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City | HARTFORD
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State | CT
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Zip | 06106-2235
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Country | US
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Telephone | 860-951-7268
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Fax | 860-951-7269
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Provider Business Mailing Address
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Address Line | PO BOX 261140
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City | HARTFORD
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State | CT
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Zip | 06126-1140
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Country | US
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Telephone | 860-951-7268
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Fax | 860-951-7269
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. THOMAS C MICHALSKI JR.
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Credential | LCSW
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Telephone | 860-951-7268
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 008119
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License Number State | CT
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