Organization
NATCHAUG HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK ANTHONY MELLEY LPC (PRIMARY THERAPIST)
(860) 963-6416
Entity
Organization
Contact information
Practice address
320 POMFRET ST, PUTNAM, CT 06260-1836
(860) 963-6416
(860) 963-6303
Mailing address
42 CAMPBELL AVE, VERNON, CT 06066-5404
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
001670
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001670
DEPARTMENT OF PUBLIC HEALTH
CT
Enumeration date
12/13/2009
Last updated
12/13/2009
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