Provider Demographics
NPI:1467504779
Name:MCCALL FOUNDATION, INC.
Entity Type:Organization
Organization Name:MCCALL FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COUTANT SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-496-2100
Mailing Address - Street 1:PO BOX 806
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-0806
Mailing Address - Country:US
Mailing Address - Phone:860-496-2100
Mailing Address - Fax:860-496-2111
Practice Address - Street 1:231 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:CT
Practice Address - Zip Code:06098-1245
Practice Address - Country:US
Practice Address - Phone:860-496-2100
Practice Address - Fax:860-496-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTSA-0071251S00000X
CTC-0248251S00000X
CTMHDT-0024251S00000X
CT0544261QM0801X
CT0451261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004159556Medicaid
CT007228757Medicaid
CT004159556Medicaid