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
01
—
312837
MHN
CT
Enumeration date
07/23/2007
Last updated
04/20/2008
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