Provider Demographics
NPI:1891087722
Name:DIXWELL/NEWHALLVILLE COMMUNITY MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:DIXWELL/NEWHALLVILLE COMMUNITY MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-776-8390
Mailing Address - Street 1:660 WINCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-1969
Mailing Address - Country:US
Mailing Address - Phone:203-776-8390
Mailing Address - Fax:203-776-4176
Practice Address - Street 1:660 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-1969
Practice Address - Country:US
Practice Address - Phone:203-776-8390
Practice Address - Fax:203-776-4176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health