Organization
FSW
Active
Organization
FSW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRANK FARIAS (CHIEF FINANCIAL & HR OFFICER)
(203) 368-4291
Entity
Organization
Contact information
Practice address
475 CLINTON AVE, BRIDGEPORT, CT 06605-1700
(203) 368-4291
(203) 368-1239
Mailing address
475 CLINTON AVE, BRIDGEPORT, CT 06605-1700
(203) 368-4291
(203) 368-1239
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
000201
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C01300
GRP#
CT
Enumeration date
05/16/2007
Last updated
11/18/2020
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