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Organization
INTERCOMMUNITY MENTAL HEALTH GROUP
Active
Organization
INTERCOMMUNITY MENTAL HEALTH GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARSHALL GAINES MBA, CPA (VICE PRESIDENT OF ADMINISTRATION)
(860) 895-2308
Entity
Organization
Contact information
Practice address
505 SILAS DEANE HWY, WETHERSFIELD, CT 06109-2216
(860) 569-5900
Mailing address
281 MAIN ST, EAST HARTFORD, CT 06118-1823
(860) 569-5900
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
C-0109
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004050993
—
CT
01
—
312837
MHN
CT
Enumeration date
07/23/2007
Last updated
04/20/2008
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