Provider Demographics
NPI:1972592186
Name:HARTFORD COMMUNITY MENTAL HEALTH CENTER INC.
Entity Type:Organization
Organization Name:HARTFORD COMMUNITY MENTAL HEALTH CENTER INC.
Other - Org Name:HARTFORD BEHAVIORA HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEMITZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-727-8703
Mailing Address - Street 1:2550 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06120-1936
Mailing Address - Country:US
Mailing Address - Phone:860-727-8703
Mailing Address - Fax:860-548-2045
Practice Address - Street 1:2550 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-1936
Practice Address - Country:US
Practice Address - Phone:860-727-8703
Practice Address - Fax:860-548-2045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0302261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02011Medicare PIN