# CLEANSLATE MEDICAL GROUP OF CONNECTICUT LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073057071
- **Authorized official:** ROBERT HUTCHISON (CFO)
- **Authorized official phone:** (615) 425-0220

## Contact information

- **Practice address:** 85 GILLETT ST, HARTFORD, CT 06105-2630
- **Practice address phone:** (615) 425-0220
- **Practice address fax:** (413) 727-3619
- **Mailing address:** 8 CADILLAC DR STE 180, BRENTWOOD, TN 37027-5393
- **Mailing address phone:** (615) 425-0220
- **Mailing address fax:** (413) 727-3619

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | NULL | Yes |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/09/2016
- **Last updated:** 03/23/2023