Provider Demographics
NPI:1043791874
Name:SPECIALIZED EDUCATION OF CONNECTICUT INC.
Entity Type:Organization
Organization Name:SPECIALIZED EDUCATION OF CONNECTICUT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:AO
Authorized Official - Phone:856-283-3456
Mailing Address - Street 1:2 AQUARIUM DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1085
Mailing Address - Country:US
Mailing Address - Phone:856-283-3456
Mailing Address - Fax:
Practice Address - Street 1:5 BARNES INDUSTRIAL RD S
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2431
Practice Address - Country:US
Practice Address - Phone:203-284-0441
Practice Address - Fax:203-774-5716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities