Organization
COMMUNITY RENEWAL TEAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA POLLICINA (CLINICIAN)
(860) 714-9200
Entity
Organization
Contact information
Practice address
675 TOWER AVE, MOB, SUITE 308, HARTFORD, CT 06112-1273
(860) 714-9200
(860) 714-8516
Mailing address
675 TOWER AVE, MOB, SUITE 308, HARTFORD, CT 06112-1273
(860) 714-9200
(860) 714-8516
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
006427
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004243747
BILLING PROVIDER NUMBER
CT
Enumeration date
04/29/2008
Last updated
11/07/2013
Update your record
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