Provider Demographics
NPI:1467500090
Name:COMMUNITY GUIDANCE CLINIC FOR CENTRAL CT, INC.
Entity Type:Organization
Organization Name:COMMUNITY GUIDANCE CLINIC FOR CENTRAL CT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEIVABLES AND BILLING SPECAILIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-235-5767
Mailing Address - Street 1:384 PRATT ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450
Mailing Address - Country:US
Mailing Address - Phone:203-235-5767
Mailing Address - Fax:203-238-2010
Practice Address - Street 1:384 PRATT ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450
Practice Address - Country:US
Practice Address - Phone:203-235-5767
Practice Address - Fax:203-238-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2024-01-09
Deactivation Date:2008-06-03
Deactivation Code:
Reactivation Date:2008-07-08
Provider Licenses
StateLicense IDTaxonomies
CT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004039210Medicaid