Provider Demographics
NPI:1134411614
Name:KHMER HEALTH ADVOCATES, INC.
Entity type:Organization
Organization Name:KHMER HEALTH ADVOCATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:THEANVY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:860-561-3345
Mailing Address - Street 1:1125 NEW BRITAIN AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-2420
Mailing Address - Country:US
Mailing Address - Phone:860-561-3345
Mailing Address - Fax:860-561-3538
Practice Address - Street 1:1125 NEW BRITAIN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-2440
Practice Address - Country:US
Practice Address - Phone:860-561-3345
Practice Address - Fax:860-561-3538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000638101YP2500X
CT003364364SP0809X
CT0148982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008035322Medicaid