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General NPI Number Information
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NPI Number | 1841569639
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Entity Type | Organization
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Legal Business Name | COMMUNITY RENEWAL TEAM, INC
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Dates
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Enumeration Date | 12/22/2011
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Last Update Date | 12/22/2011
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Provider Practice Location Address
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Address Line | 330 MARKET ST
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City | HARTFORD
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State | CT
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Zip | 06120-2901
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Country | US
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Telephone | 860-714-2010
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Fax | 860-714-8516
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Provider Business Mailing Address
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Address Line | 330 MARKET ST
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City | HARTFORD
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State | CT
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Zip | 06120-2901
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Country | US
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Telephone | 860-714-2010
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Fax | 860-714-8516
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Authorized Official
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Title or Position | CLINICIAN
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Name | ANDREA M QUICK
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Credential | LCSW
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Telephone | 860-714-2010
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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 | 007823
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License Number State | CT
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