Provider Demographics
NPI:1558561894
Name:SOUTHBURY-MIDDLEBURY YOUTH AND FAMILY SERVICES
Entity Type:Organization
Organization Name:SOUTHBURY-MIDDLEBURY YOUTH AND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANGGI
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:203-758-1441
Mailing Address - Street 1:1287 STRONGTOWN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-1948
Mailing Address - Country:US
Mailing Address - Phone:203-758-1441
Mailing Address - Fax:203-758-1658
Practice Address - Street 1:1287 STRONGTOWN RD
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-1948
Practice Address - Country:US
Practice Address - Phone:203-758-1441
Practice Address - Fax:203-758-1658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0381251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health