Organization
EASTCONN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MANDY CARVER (SERVICE COORDINATOR)
(860) 455-1590
Entity
Organization
Contact information
Practice address
376 HARTFORD TPKE, HAMPTON, CT 06247-1320
(860) 455-0707
(860) 455-8002
Mailing address
376 HARTFORD TPKE, HAMPTON, CT 06247-1320
(860) 455-0707
(860) 455-8002
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004185866
—
CT
Enumeration date
12/16/2008
Last updated
08/17/2022
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