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General NPI Number Information
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NPI Number | 1912229709
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Entity Type | Organization
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Legal Business Name | INTERLOCKING CONNECTIONS, LLC
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Dates
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Enumeration Date | 02/19/2010
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Last Update Date | 02/19/2010
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Provider Practice Location Address
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Address Line | 326 PETER GREEN RD
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City | TOLLAND
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State | CT
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Zip | 06084-2408
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Country | US
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Telephone | 860-713-3324
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Fax |
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Provider Business Mailing Address
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Address Line | 399 ENFIELD ST
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City | ENFIELD
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State | CT
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Zip | 06082-1920
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Country | US
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Telephone | 860-713-3324
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. CAROLE RYAN HANLON
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Credential | LPC, BCBA
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Telephone | 860-713-3324
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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 | 001841
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License Number State | CT
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