Provider Demographics
NPI:1093041220
Name:CONNECTICUT THERAPY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CONNECTICUT THERAPY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPANY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:HYNES
Authorized Official - Suffix:
Authorized Official - Credentials:CCDP, MATS, CAC, CCS
Authorized Official - Phone:860-868-0857
Mailing Address - Street 1:PO BOX 560
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON DEPOT
Mailing Address - State:CT
Mailing Address - Zip Code:06794-0560
Mailing Address - Country:US
Mailing Address - Phone:860-868-0857
Mailing Address - Fax:860-868-1288
Practice Address - Street 1:8 TITUS RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON DEPOT
Practice Address - State:CT
Practice Address - Zip Code:06794-1517
Practice Address - Country:US
Practice Address - Phone:860-868-0857
Practice Address - Fax:860-868-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty