Organization
CONNECTICUT COUNSELING CENTERS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON BRADWAY (DIRECTOR INFORMATION SYSTEMS)
(203) 568-7466
Entity
Organization
Contact information
Practice address
50 BROOKSIDE RD, WATERBURY, CT 06708-1402
(203) 568-7466
(203) 568-7468
Mailing address
50 BROOKSIDE RD, WATERBURY, CT 06708-1402
(203) 568-7466
(203) 568-7468
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
0533
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0533
CONNECTICUT DEPT PUBLIC HEALTH
CT
Enumeration date
11/26/2017
Last updated
11/26/2017
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