Provider Demographics
NPI:1265682827
Name:CLIFFORD BEERS CHILD GUIDANCE CLINIC
Entity Type:Organization
Organization Name:CLIFFORD BEERS CHILD GUIDANCE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDIETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-772-1270
Mailing Address - Street 1:93 EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3933
Mailing Address - Country:US
Mailing Address - Phone:203-772-1270
Mailing Address - Fax:
Practice Address - Street 1:93 EDWARDS ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3933
Practice Address - Country:US
Practice Address - Phone:203-772-1270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health