Provider Demographics
NPI:1225042542
Name:THE CHILDREN'S CENTER OF HAMDEN, INC.
Entity Type:Organization
Organization Name:THE CHILDREN'S CENTER OF HAMDEN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:LOCKERY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-248-2116
Mailing Address - Street 1:1400 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-2426
Mailing Address - Country:US
Mailing Address - Phone:203-248-2116
Mailing Address - Fax:203-287-9815
Practice Address - Street 1:1400 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517-2426
Practice Address - Country:US
Practice Address - Phone:203-248-2116
Practice Address - Fax:203-287-9815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTEDT-1261QM0855X
CTOPCC-51261QM0855X
CTSA-0093261QR0405X
CTCCF/RT-2322D00000X
CTCCF/RT-73323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004254166Medicaid
CT004040846Medicaid
CT004040846Medicaid
CT004254166Medicaid
CT=========OtherAETNA PROV ID#
CT=========OtherYALE HEALTH PLAN PROV ID#
CT=========OtherUHC PROV ID#
CT238808-00Medicare UPIN
CT=========OtherCIGNA PROV ID#
CT004040846Medicaid
CT=========OtherUHC PROV ID#
CT004254166Medicaid
CT=========OtherAETNA PROV ID#