Provider Demographics
NPI:1275717019
Name:CENTER FOR FAMILY & INDIVIDUAL PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:CENTER FOR FAMILY & INDIVIDUAL PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-872-4570
Mailing Address - Street 1:76 SOUTH FRONTAGE ROAD
Mailing Address - Street 2:P.O. BOX 2333
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-2250
Mailing Address - Country:US
Mailing Address - Phone:860-872-4570
Mailing Address - Fax:860-896-1023
Practice Address - Street 1:76 S FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-5535
Practice Address - Country:US
Practice Address - Phone:860-872-4570
Practice Address - Fax:860-896-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT703103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT06000703CT02OtherBCBS
CT62484313OtherUNITED BEHAVIORAL HEALTH
CT133603OtherVALUE OPTIONS
CTA379004OtherOXFORD
CT62741OtherCIGNA BEHAVIORAL HEALTH
CT4534633OtherAETNA
CTA379004OtherOXFORD
CT62484313OtherUNITED BEHAVIORAL HEALTH