Provider Demographics
NPI:1528361243
Name:YOUTH LIGHT FOUNDATION
Entity Type:Organization
Organization Name:YOUTH LIGHT FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICALDIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CATRAMBONE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC FLP
Authorized Official - Phone:860-567-0700
Mailing Address - Street 1:PO BOX 1655
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-1655
Mailing Address - Country:US
Mailing Address - Phone:860-567-0700
Mailing Address - Fax:860-567-5901
Practice Address - Street 1:31 EAST ST
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:CT
Practice Address - Zip Code:06763-1802
Practice Address - Country:US
Practice Address - Phone:860-567-0700
Practice Address - Fax:860-567-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000701251V00000X
CT000706251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable