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General NPI Number Information
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NPI Number | 1508134917
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Entity Type | Organization
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Legal Business Name | THE VILLAGE FOR FAMILIES AND CHILDREN
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Dates
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Enumeration Date | 12/13/2011
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Last Update Date | 04/13/2012
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Provider Practice Location Address
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Address Line | 331 WETHERSFIELD AVE
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City | HARTFORD
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State | CT
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Zip | 06114-1420
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Country | US
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Telephone | 860-236-4511
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Fax |
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Provider Business Mailing Address
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Address Line | 331 WETHERSFIELD AVE
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City | HARTFORD
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State | CT
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Zip | 06114-1420
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Country | US
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Telephone | 860-236-4511
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Fax |
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Authorized Official
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Title or Position | CLINICIAN
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Name | MS. LUZ MERCEDES LOPEZ
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Credential | MS
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Telephone | 860-236-4511
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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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