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Norwich, Connecticut

Provider NPI: 1558366757

Organization Information:
Organization is not Subpart
Authorized Official:  WILLIAM  RUSH  CFO  860-8224153

Practice Location:
Tel: 860-892-7042  Fax: 860-822-4939

Business Mailing Address:
Tel: 860-892-7042  Fax: 860-822-4939

Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
N101Y00000XBehavioral Health & Social Service Providers
N101YA0400XBehavioral Health & Social Service Providers
N101YP2500XBehavioral Health & Social Service Providers
N103TC0700XBehavioral Health & Social Service Providers
N104100000XBehavioral Health & Social Service Providers
Social Worker
N106H00000XBehavioral Health & Social Service Providers
Marriage & Family Therapist
Psychiatry & Neurology
N261QF0400XAmbulatory Health Care Facilities
Y261QF0400XAmbulatory Health Care Facilities

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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