Provider Demographics
NPI:1851695837
Name:STRATFORD COMMUNITY SERVICES
Entity Type:Organization
Organization Name:STRATFORD COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOISSEVAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-385-4090
Mailing Address - Street 1:468 BIRDSEYE ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-6976
Mailing Address - Country:US
Mailing Address - Phone:203-385-4095
Mailing Address - Fax:
Practice Address - Street 1:468 BIRDSEYE ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-6976
Practice Address - Country:US
Practice Address - Phone:203-385-4095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF STRATFORD, CT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000784106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty