Provider Demographics
NPI:1912356205
Name:CADTC PARTNERS LLC
Entity Type:Organization
Organization Name:CADTC PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIBOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-677-2550
Mailing Address - Street 1:70 N MAIN ST
Mailing Address - Street 2:POB 1215
Mailing Address - City:SHARON
Mailing Address - State:CT
Mailing Address - Zip Code:06069-2074
Mailing Address - Country:US
Mailing Address - Phone:860-397-5032
Mailing Address - Fax:
Practice Address - Street 1:1031 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1576
Practice Address - Country:US
Practice Address - Phone:860-677-2550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT364SPO809X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty