Provider Demographics
NPI:1225163876
Name:SOUTHWESTERN CONNECTICUT AGENCY ON AGING
Entity Type:Organization
Organization Name:SOUTHWESTERN CONNECTICUT AGENCY ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DELORENZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-333-9288
Mailing Address - Street 1:10 MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-4257
Mailing Address - Country:US
Mailing Address - Phone:203-333-9288
Mailing Address - Fax:203-696-3866
Practice Address - Street 1:10 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-4257
Practice Address - Country:US
Practice Address - Phone:203-333-9288
Practice Address - Fax:203-696-3866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4158946OtherCHCPE PROVIDER NUMBER