Provider Demographics
NPI:1841225489
Name:STATE OF CONNECTICUT
Entity Type:Organization
Organization Name:STATE OF CONNECTICUT
Other - Org Name:WESTERN CONNECTICUT MENTAL HEALTH NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-418-6937
Mailing Address - Street 1:55 WEST MAIN STREET
Mailing Address - Street 2:SUITE 410 ROWLAND STATE GOVERNMENT CENTER
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702
Mailing Address - Country:US
Mailing Address - Phone:203-805-6403
Mailing Address - Fax:203-805-6432
Practice Address - Street 1:55 WEST MAIN STREET
Practice Address - Street 2:SUITE 410 ROWLAND STATE GOVERNMENT CENTER
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702
Practice Address - Country:US
Practice Address - Phone:203-805-6403
Practice Address - Fax:203-805-6432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004120333Medicaid
CT004217106Medicaid
CTC02788Medicare ID - Type UnspecifiedFIRST COAST MEDICARE