Provider Demographics
NPI:1194015974
Name:GATEWAY BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:GATEWAY BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-949-8311
Mailing Address - Street 1:PO BOX 531
Mailing Address - Street 2:
Mailing Address - City:TAFTVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06380-0531
Mailing Address - Country:US
Mailing Address - Phone:860-949-8311
Mailing Address - Fax:860-949-8124
Practice Address - Street 1:165 LAWLER LN
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-9435
Practice Address - Country:US
Practice Address - Phone:860-949-8311
Practice Address - Fax:860-949-8124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare