Organization
STAYWELL HEALTH CARE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXIS ESTRADA (CREDENTIALING ADMINISTRATOR)
(203) 756-8021
Entity
Organization
Contact information
Practice address
1309 S MAIN ST, WATERBURY, CT 06706-1758
(203) 597-9044
(203) 596-9038
Mailing address
80 PHOENIX AVE, WATERBURY, CT 06702-1418
(203) 756-8021
(203) 596-9038
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
0506
CT
261QF0400X
Federally Qualified Health Center (FQHC)
0474
CT
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
0479
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004235968
—
CT
Enumeration date
05/17/2013
Last updated
02/08/2018
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