Organization
SPRINGTIDE CHILD DEVELOPMENT, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONICA HAMMEL (CREDENTIALING MANAGER)
(765) 461-5410
Entity
Organization
Contact information
Practice address
126 MONROE TPKE, TRUMBULL, CT 06611-1300
(781) 492-4991
(855) 217-6179
Mailing address
PO BOX 740, MONROE, CT 06468-0740
(203) 880-5495
(203) 816-5495
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
12/18/2019
Last updated
12/14/2021
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