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
635 MAIN ST, MIDDLETOWN, CT 06457-2718
(860) 347-6971
(860) 638-6601
Mailing address
635 MAIN ST, ATTN: CREDENTIALING DEPARTMENT, MIDDLETOWN, CT 06457-2718
(860) 347-6971
(860) 638-6601
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
0394
CT
103TC2200X
Clinical Child & Adolescent Psychologist
OPCC23
CT
1041C0700X
Clinical Social Worker
0394
CT
2084P0800X
Psychiatry Physician
0394
CT
2084P0804X
Child & Adolescent Psychiatry Physician
OPCC23
CT
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
06/10/2006
Last updated
07/16/2007
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