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General NPI Number Information
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NPI Number | 1467635326
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Entity Type | Organization
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Legal Business Name | NORTHEAST CENTER FOR YOUTH AND FAMILIES
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Dates
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Enumeration Date | 12/13/2007
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Last Update Date | 12/13/2007
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Provider Practice Location Address
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Address Line | 1556 STORRS RD
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City | MANSFIELD
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State | CT
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Zip | 06028
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Country | US
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Telephone | 860-487-4846
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Fax | 869-487-4847
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Provider Business Mailing Address
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Address Line | 1556 STORRS RD.
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City | MANSFIELD
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State | CT
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Zip | 06268
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Country | US
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Telephone | 860-487-4846
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Fax | 860-487-4847
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Authorized Official
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Title or Position | CLINICIAN
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Name | MRS. AMY JACQUELINE HUNTER
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Credential | MA, CAGS
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Telephone | 413-575-9095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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