Provider Demographics
NPI:1457823692
Name:MENTAL HEALTH AND SUBSTANCE ABUSE ASSOCIATION OF GREATER HARTFORD
Entity Type:Organization
Organization Name:MENTAL HEALTH AND SUBSTANCE ABUSE ASSOCIATION OF GREATER HARTFORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TWUMASI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-819-8954
Mailing Address - Street 1:357 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4472
Mailing Address - Country:US
Mailing Address - Phone:860-819-8954
Mailing Address - Fax:
Practice Address - Street 1:357 E CENTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4472
Practice Address - Country:US
Practice Address - Phone:860-819-8954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0005502939OtherAPPLYING FOR NPI #