Organization
CONNECTICUT RENAISSANCE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH B RIKER MBA (EXECUTIVE DIRECTOR)
20333652258
Entity
Organization
Contact information
Practice address
1126 MAIN ST, BRIDGEPORT, CT 06604-4404
(203) 333-2040
(203) 333-2152
Mailing address
350 FAIRFIELD AVE, SUITE 701, BRIDGEPORT, CT 06604-6014
(203) 336-5225
(203) 336-2851
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
0442
CT
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
0442
CT
Other
Enumeration date
11/20/2012
Last updated
01/02/2013
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