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General NPI Number Information
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NPI Number | 1992096887
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Entity Type | Organization
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Legal Business Name | HARTFORD GAY & LESBIAN HEALTH COLLECTIVE
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Dates
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Enumeration Date | 04/26/2011
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Last Update Date | 11/10/2015
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Provider Practice Location Address
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Address Line | 1841 BROAD ST
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City | HARTFORD
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State | CT
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Zip | 06114-1780
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Country | US
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Telephone | 860-278-4163
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Fax | 860-278-5995
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Provider Business Mailing Address
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Address Line | 1841 BROAD ST.
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City | HARTFORD
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State | CT
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Zip | 06114-2094
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Country | US
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Telephone | 860-278-4163
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Fax | 860-278-5995
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. LINDA M. ESTABROOK
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Credential | MPH
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Telephone | 860-278-4163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 001588
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 002904
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R49289
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 000166
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License Number State | CT
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Taxonomy #5
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 031112
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License Number State | CT
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Taxonomy #6
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 0302
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License Number State | CT
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Taxonomy #7
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 007780
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License Number State | CT
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