Provider Demographics
NPI:1881992626
Name:CORRECTIONAL MANAGEED HEALTH CARE
Entity type:Organization
Organization Name:CORRECTIONAL MANAGEED HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:860-627-2271
Mailing Address - Street 1:1153 EAST ST S
Mailing Address - Street 2:
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06080-0001
Mailing Address - Country:US
Mailing Address - Phone:860-627-2271
Mailing Address - Fax:860-627-2265
Practice Address - Street 1:1153 EAST ST S
Practice Address - Street 2:
Practice Address - City:SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06080-0001
Practice Address - Country:US
Practice Address - Phone:860-627-2271
Practice Address - Fax:860-627-2265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002217302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization