Organization
CONNECTICUT COUNSELING CENTERS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JASON E BRADWAY (DIRECTOR OF INFORMATION TECHNOLOGY)
(203) 743-4698
Entity
Organization
Contact information
Practice address
4 MIDLAND RD, WATERBURY, CT 06705-3412
(203) 755-8874
(203) 597-9570
Mailing address
4 MIDLAND RD, WATERBURY, CT 06705-3412
(203) 755-8874
(203) 597-9570
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
SA0200
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004175726
—
CT
Enumeration date
03/22/2007
Last updated
06/25/2008
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