Provider Demographics
NPI:1225249162
Name:CHEMICAL ABUSE SERVICES AGENCY, INC.
Entity Type:Organization
Organization Name:CHEMICAL ABUSE SERVICES AGENCY, INC.
Other - Org Name:MAAS AMB DETOX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ASHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DELERME
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LADC, CCS, CCDP
Authorized Official - Phone:203-339-4112
Mailing Address - Street 1:690 ARCTIC ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06608-2008
Mailing Address - Country:US
Mailing Address - Phone:203-339-4112
Mailing Address - Fax:203-339-4115
Practice Address - Street 1:426 EAST ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5018
Practice Address - Country:US
Practice Address - Phone:203-495-7710
Practice Address - Fax:203-495-7713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTSA-0120251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004251972Medicaid