Provider Demographics
NPI:1407159841
Name:CORNELL SCOTT HILL HEALTH CORPORATION
Entity Type:Organization
Organization Name:CORNELL SCOTT HILL HEALTH CORPORATION
Other - Org Name:CHILD AND FAMILY GUIDANCE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SOL
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-503-3174
Mailing Address - Street 1:PO BOX 7720
Mailing Address - Street 2:CREDENTIALING SPECIALIST
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-0720
Mailing Address - Country:US
Mailing Address - Phone:203-503-3174
Mailing Address - Fax:203-503-6515
Practice Address - Street 1:226 DIXWELL AVE
Practice Address - Street 2:DIXWELL HEALTH CENTER
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3456
Practice Address - Country:US
Practice Address - Phone:203-503-3420
Practice Address - Fax:203-503-3422
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORNELL SCOTT-HILL HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-07
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0518261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)