Provider Demographics
NPI:1851387054
Name:CENTER FOR INTERPERSONAL RELATIONS INC
Entity Type:Organization
Organization Name:CENTER FOR INTERPERSONAL RELATIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-928-5967
Mailing Address - Street 1:100 AVERILL RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:POMFRET CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06259-1800
Mailing Address - Country:US
Mailing Address - Phone:860-928-5967
Mailing Address - Fax:860-928-9237
Practice Address - Street 1:100 AVERILL RD
Practice Address - Street 2:SUITE 2
Practice Address - City:POMFRET CENTER
Practice Address - State:CT
Practice Address - Zip Code:06259-1800
Practice Address - Country:US
Practice Address - Phone:860-928-5967
Practice Address - Fax:860-928-9237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC01392OtherMEDICARE CT