Provider Demographics
NPI:1265668602
Name:CONNECTICUT BEHAVIORAL OUTREACH, INC.
Entity Type:Organization
Organization Name:CONNECTICUT BEHAVIORAL OUTREACH, INC.
Other - Org Name:CTBOINC, CTBO INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MURIEL
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:TOMER
Authorized Official - Suffix:
Authorized Official - Credentials:MAT
Authorized Official - Phone:203-626-5202
Mailing Address - Street 1:32 WOODING RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2242
Mailing Address - Country:US
Mailing Address - Phone:203-626-5202
Mailing Address - Fax:877-387-7133
Practice Address - Street 1:32 WOODING RD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2242
Practice Address - Country:US
Practice Address - Phone:203-626-5202
Practice Address - Fax:877-387-7133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management