Provider Demographics
NPI:1073548533
Name:INTERCOMMUNITY, INC.
Entity Type:Organization
Organization Name:INTERCOMMUNITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEAUREGARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-569-5900
Mailing Address - Street 1:281 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06118-1883
Mailing Address - Country:US
Mailing Address - Phone:860-569-5900
Mailing Address - Fax:860-569-5614
Practice Address - Street 1:281 MAIN STREET
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06118-1883
Practice Address - Country:US
Practice Address - Phone:860-569-5900
Practice Address - Fax:860-569-5614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC0178261QM0801X
CT702261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004050993Medicaid
312837OtherMHN
CT008047966Medicaid
312837OtherMHN