Provider Demographics
NPI:1043410954
Name:MENTAL HEALTH ASSOCIATION OF CONNECTICUT, INC
Entity Type:Organization
Organization Name:MENTAL HEALTH ASSOCIATION OF CONNECTICUT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:860-529-1970
Mailing Address - Street 1:20-30 BEAVER RD STE 108
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-2242
Mailing Address - Country:US
Mailing Address - Phone:860-529-1970
Mailing Address - Fax:860-529-6833
Practice Address - Street 1:20-30 BEAVER RD STE 108
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-2242
Practice Address - Country:US
Practice Address - Phone:860-529-1970
Practice Address - Fax:860-529-6833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTRLC-0028320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness