Organization
CT YOUTH RESOURCES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIELLE FORKO LPC (EXECUTIVE DIRECTOR)
(203) 658-7779
Entity
Organization
Contact information
Practice address
445 WASHINGTON AVE, NORTH HAVEN, CT 06473-1320
(203) 658-7779
Mailing address
445 WASHINGTON AVE, NORTH HAVEN, CT 06473-1320
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
097031759
CT
Other
Enumeration date
03/28/2016
Last updated
03/28/2016
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