Provider Demographics
NPI:1508192725
Name:FAMILY RESOURCE AND DEVELOPMENT CENTER, LLC
Entity Type:Organization
Organization Name:FAMILY RESOURCE AND DEVELOPMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:860-677-0028
Mailing Address - Street 1:41 N MAIN ST
Mailing Address - Street 2:303
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1972
Mailing Address - Country:US
Mailing Address - Phone:860-838-4735
Mailing Address - Fax:860-461-1514
Practice Address - Street 1:41 N MAIN ST
Practice Address - Street 2:303
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1972
Practice Address - Country:US
Practice Address - Phone:860-838-4735
Practice Address - Fax:860-461-1514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000361101YM0800X
CT0053361041C0700X
CT000859106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty