Provider Demographics
NPI:1760983720
Name:CENTRAL CT ANXIETY OCD TREATMENT LLC
Entity Type:Organization
Organization Name:CENTRAL CT ANXIETY OCD TREATMENT LLC
Other - Org Name:TAMMY VANLINTER LCSW LADY THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:VANLINTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW LADC
Authorized Official - Phone:860-436-2250
Mailing Address - Street 1:35 COLD SPRING RD STE 122
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-3161
Mailing Address - Country:US
Mailing Address - Phone:860-436-2250
Mailing Address - Fax:860-619-8919
Practice Address - Street 1:35 COLD SPRING RD STE 122
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-3161
Practice Address - Country:US
Practice Address - Phone:860-436-2250
Practice Address - Fax:860-619-8919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0088951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD300203136Medicaid