Provider Demographics
NPI:1225063860
Name:STATE OF CONNECTICUT
Entity Type:Organization
Organization Name:STATE OF CONNECTICUT
Other - Org Name:PROBLEM GAMBLING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALBEA
Authorized Official - Last Name:CROMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-418-6923
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:2 VANCE DRIVE RUSSELL HALL CONNECTICUT VALLEY HOSPITAL
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457
Mailing Address - Country:US
Mailing Address - Phone:860-262-6601
Mailing Address - Fax:860-344-2360
Practice Address - Street 1:2 VANCE DRIVE RUSSELL HALL
Practice Address - Street 2:CONNECTICUT VALLEY HOSPITAL
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457
Practice Address - Country:US
Practice Address - Phone:860-262-6601
Practice Address - Fax:860-344-2360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health