Connecticut Violence Intervention Program, Inc.

Primary specialty

Prevention ProfessionalTaxonomy code 405300000X

Legal business name

CONNECTICUT VIOLENCE INTERVENTION PROGRAM, INC.

Practice address

230 Ashmun St
New Haven, CT 06511-3574

Phone

(203) 410-2580

NPI assigned

Sep 28, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michaela Fraser Reilly

Title

Marketing, Technology & Research

Phone

(201) 783-4921

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1664323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664323200000",
    "number": "1013631506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 ASHMUN ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065113574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 ASHMUN ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065113574",
            "telephone_number": "203-410-2580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT VIOLENCE INTERVENTION PROGRAM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-28",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A",
        "authorized_official_last_name": "REILLY",
        "authorized_official_first_name": "MICHAELA",
        "authorized_official_middle_name": "FRASER",
        "authorized_official_title_or_position": "MARKETING, TECHNOLOGY & RESEARCH",
        "authorized_official_telephone_number": "201-783-4921"
    },
    "taxonomies": [
        {
            "code": "405300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Prevention Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Prevention Professional in New Haven, CT
• Providers in New Haven, CT by specialty
• Prevention Professional in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.