Provider Demographics
NPI:1073565198
Name:CONNECTIC UT MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:CONNECTIC UT MENTAL HEALTH SERVICES
Other - Org Name:GERIATRIC MENTAL HEALTH SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISCENSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1860-677-5570
Mailing Address - Street 1:25 MIDDLEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1245
Mailing Address - Country:US
Mailing Address - Phone:186-023-6812
Mailing Address - Fax:
Practice Address - Street 1:270 FARMINGTON AVE
Practice Address - Street 2:BUILDING ONE
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1909
Practice Address - Country:US
Practice Address - Phone:860-677-5570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0022111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty