Provider Demographics
NPI:1093908899
Name:CONNECTICUT CHILDREN & FAMILY CTR. INC
Entity Type:Organization
Organization Name:CONNECTICUT CHILDREN & FAMILY CTR. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:CONAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-772-4228
Mailing Address - Street 1:230 ASHMUN ST
Mailing Address - Street 2:BOX 4
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3549
Mailing Address - Country:US
Mailing Address - Phone:203-772-4228
Mailing Address - Fax:203-776-1982
Practice Address - Street 1:230 ASHMUN ST
Practice Address - Street 2:BOX 4
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3549
Practice Address - Country:US
Practice Address - Phone:203-772-4228
Practice Address - Fax:203-776-1982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health