Provider Demographics
NPI:1457018343
Name:THE CENTER FOR CONNECTION AND CHANGE LLC
Entity Type:Organization
Organization Name:THE CENTER FOR CONNECTION AND CHANGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRENICKI
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-856-4449
Mailing Address - Street 1:1371 BOSTON POST RD # 1022
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-2755
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44 KNEEN ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-3912
Practice Address - Country:US
Practice Address - Phone:203-856-4449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)