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General NPI Number Information
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NPI Number | 1720130362
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Entity Type | Organization
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Legal Business Name | CONNECTICUT RENAISSANCE, INC.
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 12/02/2022
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Provider Practice Location Address
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Address Line | 1126 MAIN ST
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City | BRIDGEPORT
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State | CT
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Zip | 06604-4404
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Country | US
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Telephone | 203-368-9755
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Fax | 203-368-9760
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Provider Business Mailing Address
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Address Line | 1 WATERVIEW DR STE 202
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City | SHELTON
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State | CT
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Zip | 06484-4368
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Country | US
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Telephone | 203-336-5225
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Fax | 203-336-2851
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Authorized Official
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Title or Position | COO
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Name | DAWN E PATSTON
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Credential | LMFT
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Telephone | 203-336-5225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 0412
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 0350
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License Number State | CT
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