Organization
FAMILY INTERVENTION CENTER, INC
Active
Organization
FAMILY INTERVENTION CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH E. FUTSCHIK L.C.S.W. (PRESIDENT)
(203) 753-2153
Entity
Organization
Contact information
Practice address
22 CHASE RIVER RD, WATERBURY, CT 06704-1408
(203) 753-2153
(203) 756-6032
Mailing address
22 CHASE RIVER RD, WATERBURY, CT 06704-1408
(203) 753-2153
(203) 756-6032
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0390
CT
261Q00000X
Clinic/Center
Primary
0390
CT
261QM0850X
Adult Mental Health Clinic/Center
0471
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004065439
—
CT
01
—
140001006CT01
ANTHEM
CT
Enumeration date
07/21/2005
Last updated
10/02/2023
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