Organization
COURAGE TO BE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YANIQUE J GRANT (CLINICAL SOCIAL WORKER)
(860) 245-1027
Entity
Organization
Contact information
Practice address
34 JEROME AVE STE 116, BLOOMFIELD, CT 06002-2463
(860) 245-1027
Mailing address
78 MONTOWESE ST, HARTFORD, CT 06114-3041
(860) 245-1027
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649638735
—
CT
Enumeration date
05/28/2019
Last updated
05/28/2019
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