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General NPI Number Information
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NPI Number | 1962926576
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Entity Type | Organization
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Legal Business Name | CHILD AND FAMILY AGENCY OF SOUTHEASTERN CONNECTICUT, INC.
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Dates
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Enumeration Date | 07/26/2017
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Last Update Date | 06/20/2019
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Provider Practice Location Address
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Address Line | 36 WALLER ST
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City | NEW LONDON
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State | CT
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Zip | 06320-5216
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Country | US
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Telephone | 860-437-6480
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Fax | 860-701-3772
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Provider Business Mailing Address
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Address Line | 255 HEMPSTEAD ST
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City | NEW LONDON
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State | CT
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Zip | 06320-6204
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Country | US
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Telephone | 860-443-2896
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Fax | 860-442-5909
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Authorized Official
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Title or Position | CHIEF FINANCIAL AND ADMIN OFFICER
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Name | LISA BAXTER
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Credential |
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Telephone | 860-443-2896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 0138
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License Number State | CT
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