Provider Demographics
NPI:1841409786
Name:HAVEN HEALTH CENTER OF FARMINGTON
Entity type:Organization
Organization Name:HAVEN HEALTH CENTER OF FARMINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:NICOLL
Authorized Official - Last Name:CHORONZY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:860-677-1671
Mailing Address - Street 1:16-20 FOREST GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-6662
Mailing Address - Country:US
Mailing Address - Phone:203-668-0695
Mailing Address - Fax:
Practice Address - Street 1:16-20 FOREST GLEN CIR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-6662
Practice Address - Country:US
Practice Address - Phone:203-668-0695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002780225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty