Provider Demographics
NPI:1689385585
Name:CONNECTICUT INDIVIDUAL FAMILY AND MENTAL HEALTH PRACTITIONERS
Entity Type:Organization
Organization Name:CONNECTICUT INDIVIDUAL FAMILY AND MENTAL HEALTH PRACTITIONERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LEILA LINNTOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:JARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, PHD
Authorized Official - Phone:914-772-4363
Mailing Address - Street 1:11 CEDARLAND CT
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-1710
Mailing Address - Country:US
Mailing Address - Phone:914-772-4363
Mailing Address - Fax:
Practice Address - Street 1:175 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-1818
Practice Address - Country:US
Practice Address - Phone:914-772-4363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty