Provider Demographics
NPI:1831314269
Name:CATHOLIC CHARITIES OF FAIRFIELD COUNTY, INC.
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF FAIRFIELD COUNTY, INC.
Other - Org Name:CATHOLIC CHARITIES - STAMFORD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT & CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-416-1307
Mailing Address - Street 1:30 MYANO LN
Mailing Address - Street 2:SUITE 12
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-4532
Mailing Address - Country:US
Mailing Address - Phone:203-323-1105
Mailing Address - Fax:203-323-1108
Practice Address - Street 1:30 MYANO LN
Practice Address - Street 2:SUITE 12
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-4532
Practice Address - Country:US
Practice Address - Phone:203-323-1105
Practice Address - Fax:203-323-1108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Not Answered261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Not Answered261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC01502Medicare PIN