Organization
CONNECTICUT RENAISSANCE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOY NICOLE PENDOLA (COO)
(203) 336-5225
Entity
Organization
Contact information
Practice address
141 FRANKLIN ST, STAMFORD, CT 06901-1014
(203) 602-4441
(203) 602-7782
Mailing address
350 FAIRFIELD AVE, SUITE 701, BRIDGEPORT, CT 06604-6014
(203) 336-5225
(203) 226-2851
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
C-0266
CT
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
SA-0188
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004214277
—
CT
Enumeration date
08/02/2006
Last updated
07/08/2019
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