Provider Demographics
NPI:1073526968
Name:CLIFFORD W. BEERS GUIDANCE CLINIC INC
Entity Type:Organization
Organization Name:CLIFFORD W. BEERS GUIDANCE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PROJECT MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-772-1270
Mailing Address - Street 1:93 EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3933
Mailing Address - Country:US
Mailing Address - Phone:203-772-1270
Mailing Address - Fax:203-772-0051
Practice Address - Street 1:93 EDWARDS ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3933
Practice Address - Country:US
Practice Address - Phone:203-772-1270
Practice Address - Fax:203-772-0051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101YA0400X, 103TC0700X, 1041C0700X, 106H00000X, 2084P0804X, 261QM0801X, 261QM0855X
261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004039178Medicaid