Provider Demographics
NPI:1144578741
Name:COMMUNITY SUBSTANCE ABUSE CENTER
Entity Type:Organization
Organization Name:COMMUNITY SUBSTANCE ABUSE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER/COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:CECILIA
Authorized Official - Last Name:BRACAMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:860-247-8300
Mailing Address - Street 1:55 FISH FRY STREET
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06120
Mailing Address - Country:US
Mailing Address - Phone:860-247-8300
Mailing Address - Fax:860-548-7325
Practice Address - Street 1:55 FISH FRY STREET
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120
Practice Address - Country:US
Practice Address - Phone:860-247-8300
Practice Address - Fax:860-548-7325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management