Provider Demographics
NPI:1760812432
Name:CHILD GUIDANCE CENTER OF SOUTHERN CONNECTICUT
Entity Type:Organization
Organization Name:CHILD GUIDANCE CENTER OF SOUTHERN CONNECTICUT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORK INTERN
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-517-3316
Mailing Address - Street 1:103 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3713
Mailing Address - Country:US
Mailing Address - Phone:203-324-6127
Mailing Address - Fax:203-348-9378
Practice Address - Street 1:103 W BROAD ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3713
Practice Address - Country:US
Practice Address - Phone:203-324-6127
Practice Address - Fax:203-348-9378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health