Provider Demographics
NPI:1518985183
Name:TOWN OF EAST HAVEN EAST HAVEN COUNSELING AND COMMUNITY SERVICES
Entity Type:Organization
Organization Name:TOWN OF EAST HAVEN EAST HAVEN COUNSELING AND COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPC
Authorized Official - Phone:203-468-3297
Mailing Address - Street 1:595 THOMPSON AVE
Mailing Address - Street 2:EAST HAVEN COUNSELING & COMMUNITY SERVICES
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512
Mailing Address - Country:US
Mailing Address - Phone:203-468-3297
Mailing Address - Fax:203-468-3334
Practice Address - Street 1:595 THOMPSON AVE
Practice Address - Street 2:EAST HAVEN COUNSELING & COMMUNITY SERVICES
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512
Practice Address - Country:US
Practice Address - Phone:203-468-3297
Practice Address - Fax:203-468-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC01936Medicaid
CTC01936Medicaid