Provider Demographics
NPI:1205259538
Name:CHILD GUIDANCE CENTER OF SOUTHERN CONNECTICUT
Entity type:Organization
Organization Name:CHILD GUIDANCE CENTER OF SOUTHERN CONNECTICUT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MIRLANDE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESSAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-517-3383
Mailing Address - Street 1:103 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3713
Mailing Address - Country:US
Mailing Address - Phone:203-517-3383
Mailing Address - Fax:
Practice Address - Street 1:103 W BROAD ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3713
Practice Address - Country:US
Practice Address - Phone:203-517-3383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization