Provider Demographics
NPI:1598764474
Name:FAMILY INTERVENTION CENTER, INC
Entity Type:Organization
Organization Name:FAMILY INTERVENTION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:FUTSCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-753-2153
Mailing Address - Street 1:22 CHASE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06704-1408
Mailing Address - Country:US
Mailing Address - Phone:203-753-2153
Mailing Address - Fax:203-756-6032
Practice Address - Street 1:22 CHASE RIVER RD
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-1408
Practice Address - Country:US
Practice Address - Phone:203-753-2153
Practice Address - Fax:203-756-6032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0390101YA0400X, 261Q00000X
CT0471261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT140001006CT01OtherANTHEM
CT004065439Medicaid
CT=========OtherINSURANCE
CT=========OtherINSURANCE