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General NPI Number Information
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NPI Number | 1518374859
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Entity Type | Organization
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Legal Business Name | YOUTH CONTINUUM
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Dates
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Enumeration Date | 07/18/2014
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Last Update Date | 07/21/2014
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Provider Practice Location Address
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Address Line | 705 ROBERT FROST DR
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City | BRANFORD
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State | CT
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Zip | 06405-5838
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Country | US
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Telephone | 203-468-1173
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Fax | 203-468-1259
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Provider Business Mailing Address
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Address Line | 24 RIVER ST
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City | NEW HAVEN
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State | CT
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Zip | 06513-4317
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Country | US
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Telephone | 203-562-3396
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Fax | 203-867-5888
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Authorized Official
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Title or Position | MENTAL HEALTH CLINICIAN
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Name | MRS. SASHA MARISSA GELBAND
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Credential | LCSW
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Telephone | 203-562-3396
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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 | 108295302
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License Number State | CT
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