Provider Demographics
NPI:1417030651
Name:INTERFACE CENTER INC
Entity Type:Organization
Organization Name:INTERFACE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCNALLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-354-1596
Mailing Address - Street 1:46 DANBURY RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776
Mailing Address - Country:US
Mailing Address - Phone:860-354-1596
Mailing Address - Fax:860-350-2189
Practice Address - Street 1:46 DANBURY RD
Practice Address - Street 2:SUITE 6
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776
Practice Address - Country:US
Practice Address - Phone:860-354-1596
Practice Address - Fax:860-350-2189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103T00000X, 103TC0700X, 1041C0700X, 106H00000X
CT000964103TC0700X
CT001600103TC0700X
CT0025241041C0700X
CT0026991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
002524OtherANTHEM
CTCO1176Medicare ID - Type Unspecified