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General NPI Number Information
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NPI Number | 1598764474
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Entity Type | Organization
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Legal Business Name | FAMILY INTERVENTION CENTER, INC
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Dates
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Enumeration Date | 07/21/2005
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 22 CHASE RIVER RD
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City | WATERBURY
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State | CT
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Zip | 06704-1408
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Country | US
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Telephone | 203-753-2153
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Fax | 203-756-6032
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Provider Business Mailing Address
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Address Line | 22 CHASE RIVER RD
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City | WATERBURY
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State | CT
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Zip | 06704-1408
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Country | US
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Telephone | 203-753-2153
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Fax | 203-756-6032
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOSEPH E. FUTSCHIK
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Credential | L.C.S.W.
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Telephone | 203-753-2153
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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 | 0471
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0390
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 0390
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License Number State | CT
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