Provider Demographics
NPI:1518173848
Name:DIXWELLNEWHALVILLE COMMUNITY MENTAL HEALTH
Entity Type:Organization
Organization Name:DIXWELLNEWHALVILLE COMMUNITY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PAIGE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-776-8390
Mailing Address - Street 1:197 BURWELL ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-4609
Mailing Address - Country:US
Mailing Address - Phone:203-558-6219
Mailing Address - Fax:
Practice Address - Street 1:197 BURWELL ST
Practice Address - Street 2:660 WINCHESTER AVE.
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-4609
Practice Address - Country:US
Practice Address - Phone:203-776-8390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC 0154251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health