Provider Demographics
NPI:1518914746
Name:SOUTHINGTON BEHAVIORAL HEALTH CENTER FOR CHILDREN AND FAMILIES, LLC
Entity Type:Organization
Organization Name:SOUTHINGTON BEHAVIORAL HEALTH CENTER FOR CHILDREN AND FAMILIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:SIRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-276-9295
Mailing Address - Street 1:41 OLD TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-3633
Mailing Address - Country:US
Mailing Address - Phone:860-276-9295
Mailing Address - Fax:860-276-9296
Practice Address - Street 1:41 OLD TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-3633
Practice Address - Country:US
Practice Address - Phone:860-276-9295
Practice Address - Fax:860-276-9296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CT0351322084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT=========OtherTAX ID NUMBER