Provider Demographics
NPI:1205357134
Name:NORTH CENTRAL CONNECTICUT PSYCHOTHERAPY
Entity Type:Organization
Organization Name:NORTH CENTRAL CONNECTICUT PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALIENGENA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MBA
Authorized Official - Phone:413-478-1764
Mailing Address - Street 1:54 GILLETTE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:880 BURBANK AVE
Practice Address - Street 2:
Practice Address - City:SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06078-1459
Practice Address - Country:US
Practice Address - Phone:413-478-1764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-30
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty