Provider Demographics
NPI:1679748628
Name:COMMUNITY RENEWAL TEAM
Entity Type:Organization
Organization Name:COMMUNITY RENEWAL TEAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLICINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-714-9200
Mailing Address - Street 1:675 TOWER AVE
Mailing Address - Street 2:MOB, SUITE 308
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-1273
Mailing Address - Country:US
Mailing Address - Phone:860-714-9200
Mailing Address - Fax:860-714-8516
Practice Address - Street 1:675 TOWER AVE
Practice Address - Street 2:MOB, SUITE 308
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-1273
Practice Address - Country:US
Practice Address - Phone:860-714-9200
Practice Address - Fax:860-714-8516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0064271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004243747OtherBILLING PROVIDER NUMBER