Provider Demographics
NPI:1972724888
Name:CHILD ADULT AND ADDICTION PSYCHIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:CHILD ADULT AND ADDICTION PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:VIVEK
Authorized Official - Middle Name:
Authorized Official - Last Name:AGNIHOTRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-785-8655
Mailing Address - Street 1:123 YORK ST
Mailing Address - Street 2:SUITE 1-D
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5614
Mailing Address - Country:US
Mailing Address - Phone:203-785-8655
Mailing Address - Fax:203-785-8422
Practice Address - Street 1:123 YORK ST
Practice Address - Street 2:SUITE 1-D
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5614
Practice Address - Country:US
Practice Address - Phone:203-785-8655
Practice Address - Fax:203-785-8422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0411422084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty