Organization
CONNECTICUT COUNSELING CENTERS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON BRADWAY (DIRECTOR OF INFORMATION SYSTEMS)
(203) 568-7466
Entity
Organization
Contact information
Practice address
15 COMMERCE RD LOWR 1, STAMFORD, CT 06902-4553
(203) 653-3808
(203) 653-3809
Mailing address
50 BROOKSIDE RD, WATERBURY, CT 06708-1402
(203) 568-7466
(203) 568-7468
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
0936
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0936
CONNECTICUT DEPARTMENT OF PUBLIC HEALTH
CT
Enumeration date
05/22/2018
Last updated
05/22/2018
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