Provider Demographics
NPI:1386867174
Name:OLD SAYBROOK YOUTH AND FAMILY SERVICES
Entity Type:Organization
Organization Name:OLD SAYBROOK YOUTH AND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FREUNDLICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-395-3190
Mailing Address - Street 1:322 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475
Mailing Address - Country:US
Mailing Address - Phone:860-395-3190
Mailing Address - Fax:
Practice Address - Street 1:322 MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-2350
Practice Address - Country:US
Practice Address - Phone:860-395-3190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty