Organization
CONNECTICUT COUNSELING CENTERS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON BRADWAY (DIRECTOR OF INFORMATION SYSTEMS)
(203) 568-7466
Entity
Organization
Contact information
Practice address
290 PRATT ST STE 2312, MERIDEN, CT 06450-8600
(203) 317-2500
(203) 317-2525
Mailing address
50 BROOKSIDE RD, WATERBURY, CT 06708-1402
(203) 568-7466
(203) 568-7468
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
MHDT0070
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MHDT0070
CONNECTICUT DEPT PUBLIC HEALTH
CT
01
—
SA0564
CONNECTICUT DEPT PUBLIC HEALTH
CT
Enumeration date
03/26/2018
Last updated
03/26/2018
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