Provider Demographics
NPI:1801050398
Name:ANDOVER, HEBRON, MARLBOROUGH YOUTH & FAMILY SERVICES, INC.
Entity type:Organization
Organization Name:ANDOVER, HEBRON, MARLBOROUGH YOUTH & FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DEPARTMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:KATE
Authorized Official - Last Name:EKVALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-228-9488
Mailing Address - Street 1:25 PENDLETON DR
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:CT
Mailing Address - Zip Code:06248-1525
Mailing Address - Country:US
Mailing Address - Phone:860-228-9488
Mailing Address - Fax:860-228-1213
Practice Address - Street 1:25 PENDLETON DR
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:CT
Practice Address - Zip Code:06248-1525
Practice Address - Country:US
Practice Address - Phone:860-228-9488
Practice Address - Fax:860-228-1213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008064980Medicaid
CT004258192Medicaid
CT008014267Medicaid