=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881728517
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF NORWICH-NORWICH YOUTH AND FAMILY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 80 BROADWAY
-----------------------------------------------------
City | NORWICH
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06360-5702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-823-3782
-----------------------------------------------------
Fax | 860-892-6031
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 80 BROADWAY
-----------------------------------------------------
City | NORWICH
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06360-5702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-823-3782
-----------------------------------------------------
Fax | 860-892-6031
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CITY MANAGER
-----------------------------------------------------
Name | ROBERT ZARNETSKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 860-823-3747
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 000460
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 000382
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------