Provider Demographics
NPI:1235788407
Name:FTN CT HOLDINGS. LLC
Entity Type:Organization
Organization Name:FTN CT HOLDINGS. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL AND CHIEF ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KILLHEFFER
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:860-612-2312
Mailing Address - Street 1:300 JOHN DOWNEY DR
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-2925
Mailing Address - Country:US
Mailing Address - Phone:860-612-2312
Mailing Address - Fax:
Practice Address - Street 1:270 JOHN DOWNEY DR
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-2906
Practice Address - Country:US
Practice Address - Phone:860-612-2309
Practice Address - Fax:860-612-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty