Provider Demographics
NPI:1437437431
Name:COURAGE TO GROW, LLC
Entity Type:Organization
Organization Name:COURAGE TO GROW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ISAAC
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-664-3592
Mailing Address - Street 1:162 B EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413
Mailing Address - Country:US
Mailing Address - Phone:860-664-3592
Mailing Address - Fax:860-664-3906
Practice Address - Street 1:162 B EAST MAIN STREET
Practice Address - Street 2:COURAGE TO GROW, LLC
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413
Practice Address - Country:US
Practice Address - Phone:860-664-3592
Practice Address - Fax:860-664-3906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0059111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008002029Medicaid
CT9560177OtherAETNA
CTP4074057OtherOXFORD
CT0062-0087436OtherUNITED HEALTHCARE SERVICES, INC.
CT469787OtherMHN
CT140005911CT01OtherANTHEM
CT9560177OtherAETNA PROVIDER
CT9560177OtherAETNA PROVIDER