Organization
COMMUNITY HEALTH CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BAIN PATRIE (CREDENTIALING SPECIALIST)
(860) 347-6971
Entity
Organization
Contact information
Practice address
675 MAIN ST, MIDDLETOWN, CT 06457-2718
(860) 347-6971
(860) 343-7379
Mailing address
575 MAIN ST FL 2, ATTN: CREDENTIALING DEPT, MIDDLETOWN, CT 06457-2845
(860) 347-6971
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
1223G0001X
General Practice Dentistry
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
2084P0800X
Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
213E00000X
Podiatrist
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004236338
—
CT
05
—
004236346
—
CT
05
—
004236354
—
CT
Enumeration date
07/26/2007
Last updated
05/21/2012
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