=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629441019
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHERN CONNECTICUT BEHAVIORAL HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2015
-----------------------------------------------------
Last Update Date | 11/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 203 BROAD ST SUITE C-4
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06460-4751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-685-3443
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 203 BROAD ST SUITE C-4
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06460-4751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-685-3443
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, MANAGER
-----------------------------------------------------
Name | MR. RALPH ARNONE
-----------------------------------------------------
Credential | MSW, LCSW
-----------------------------------------------------
Telephone | 203-685-3443
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | O04559
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------