Provider Demographics
NPI:1518261999
Name:KLINGBERG COMPREHENSIVE FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:KLINGBERG COMPREHENSIVE FAMILY SERVICES, INC.
Other - Org Name:KLINGBERG FAMILY CENTERS EDT
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT OF COMMUNITY SERVICE
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE-HAWWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:860-243-4416
Mailing Address - Street 1:157 CHARTER OAK AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-1913
Mailing Address - Country:US
Mailing Address - Phone:860-243-4416
Mailing Address - Fax:860-243-4418
Practice Address - Street 1:370 LINWOOD ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1949
Practice Address - Country:US
Practice Address - Phone:860-832-5575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTEDT-9251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004246147Medicaid