Provider Demographics
NPI:1245300433
Name:DIXWELL-NEWHALLVILLE COMMUNITY MENTAL HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:DIXWELL-NEWHALLVILLE COMMUNITY MENTAL HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-776-8390
Mailing Address - Street 1:660 WINCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-1969
Mailing Address - Country:US
Mailing Address - Phone:203-776-8390
Mailing Address - Fax:203-773-0788
Practice Address - Street 1:660 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-1969
Practice Address - Country:US
Practice Address - Phone:203-776-8390
Practice Address - Fax:203-773-0788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC-0154261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004061396Medicaid
CTC01527Medicare ID - Type UnspecifiedGROUP NUMBER