Provider Demographics
NPI:1013631506
Name:CONNECTICUT VIOLENCE INTERVENTION PROGRAM, INC.
Entity Type:Organization
Organization Name:CONNECTICUT VIOLENCE INTERVENTION PROGRAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARKETING, TECHNOLOGY & RESEARCH
Authorized Official - Prefix:
Authorized Official - First Name:MICHAELA
Authorized Official - Middle Name:FRASER
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-783-4921
Mailing Address - Street 1:230 ASHMUN ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3574
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:230 ASHMUN ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3574
Practice Address - Country:US
Practice Address - Phone:203-410-2580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty