Provider Demographics
NPI:1831145606
Name:CONNECTICUT MENTAL HEALTH SPECIALISTS
Entity Type:Organization
Organization Name:CONNECTICUT MENTAL HEALTH SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISCENSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-677-5570
Mailing Address - Street 1:270 FARMINGTON AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1909
Mailing Address - Country:US
Mailing Address - Phone:860-677-5570
Mailing Address - Fax:860-677-9570
Practice Address - Street 1:270 FARMINGTON AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1909
Practice Address - Country:US
Practice Address - Phone:860-677-5570
Practice Address - Fax:860-677-9570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0021261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800003666Medicare ID - Type Unspecified