Provider Demographics
NPI:1639581317
Name:YOUTH & FAMILY SERVICES OF HADDAM-KILLINGWORTH INC
Entity Type:Organization
Organization Name:YOUTH & FAMILY SERVICES OF HADDAM-KILLINGWORTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-345-7498
Mailing Address - Street 1:91 LITTLE CITY RD
Mailing Address - Street 2:
Mailing Address - City:HIGGANUM
Mailing Address - State:CT
Mailing Address - Zip Code:06441-4323
Mailing Address - Country:US
Mailing Address - Phone:860-345-7498
Mailing Address - Fax:860-345-0049
Practice Address - Street 1:91 LITTLE CITY RD
Practice Address - Street 2:
Practice Address - City:HIGGANUM
Practice Address - State:CT
Practice Address - Zip Code:06441-4323
Practice Address - Country:US
Practice Address - Phone:860-345-7498
Practice Address - Fax:860-345-0049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000992106H00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty