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NPI Code Detail

MEDICARE: FAMILY INTERVENTION CENTER, INC

MEDICARE: FAMILY INTERVENTION CENTER, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0850XAdult Mental Health Clinic/Center0471CT
2101YA0400XAddiction (Substance Use Disorder) Counselor0390CT
3261Q00000XClinic/Center0390CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1140001006CT01OTHERCTANTHEM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598764474
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILY INTERVENTION CENTER, INC
Provider Business Mailing Address
First Line : 22 CHASE RIVER RD
Second Line :
City : WATERBURY
State : CT
Zip : 06704-1408
Country : US
Telephone Number : 203-753-2153
Fax Number : 203-756-6032
Provider Business Practice Location Address
First Line : 22 CHASE RIVER RD
Second Line :
City : WATERBURY
State : CT
Zip : 06704-1408
Country : US
Telephone Number : 203-753-2153
Fax Number : 203-756-6032
Authorized Official
Title or Position : PRESIDENT
Name : MR. JOSEPH E. FUTSCHIK
Credential : L.C.S.W.
Telephone Number : 203-753-2153
Provider Enumeration Date : 07/21/2005
Last Update Date : 10/02/2023

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1831526169 — MS. DANYELLA MARIE PEREZ DARC
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