Organization
INTERCOMMUNITY, INC.
Active
Organization
INTERCOMMUNITY, INC.
Active
Other names
Outpatient Counseling Center, InterCommunity Recovery Centers
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY L BEAUREGARD LCSW (PRESIDENT & CEO)
(860) 291-1340
Entity
Organization
Contact information
Practice address
16 COVENTRY STREET, HARTFORD, CT 06112
(860) 714-3701
(860) 714-8974
Mailing address
111 FOUNDERS PLAZA, SUITE 1802, EAST HARTFORD, CT 06108
(860) 714-3701
(860) 714-8974
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
SA-0159
CT
324500000X
Substance Abuse Rehabilitation Facility
Primary
SA-0201
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004042065
—
CT
05
—
004134730
—
CT
01
—
CTGA000422
SAGA
CT
Enumeration date
12/04/2006
Last updated
06/16/2018
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