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General NPI Number Information
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NPI Number | 1447741889
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Entity Type | Organization
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Legal Business Name | CONNECTICUT COUNSELING CENTERS INC
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 15 COMMERCE RD LOWR 1
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City | STAMFORD
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State | CT
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Zip | 06902-4553
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Country | US
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Telephone | 203-653-3808
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Fax | 203-653-3809
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Provider Business Mailing Address
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Address Line | 50 BROOKSIDE RD
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City | WATERBURY
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State | CT
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Zip | 06708-1402
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Country | US
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Telephone | 203-568-7466
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Fax | 203-568-7468
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Authorized Official
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Title or Position | DIRECTOR OF INFORMATION SYSTEMS
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Name | JASON BRADWAY
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Credential |
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Telephone | 203-568-7466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 0936
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License Number State | CT
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