Connecticut Renaissance, Inc.

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

License

0442 Issued in CT

Legal business name

CONNECTICUT RENAISSANCE, INC.

Practice address

1126 Main St
Bridgeport, CT 06604-4404

Phone

(203) 333-2040

Fax

(203) 333-2152

NPI assigned

Nov 20, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Joseph B Riker, MBA

Title

Executive Director

Phone

20333652258

Specialties & licenses 2

Addresses

Tax ID family

Connecticut Renaissance Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

• Connecticut Renaissance, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Norwalk, CT
  • NPI 1265449359
  NPD tax ID
• Connecticut Renaissance, Inc

  • Substance Abuse Rehabilitation Facility
  • Waterbury, CT
  • NPI 1598817140
  NPD tax ID
• Connecticut Renaissance, Inc

  • Substance Abuse Rehabilitation Facility
  • Waterbury, CT
  • NPI 1649321696
  NPD tax ID
• Connecticut Renaissance, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Norwalk, CT
  • NPI 1144510694
  NPD tax ID
• Connecticut Renaissance, Inc.

  • Mental Health Counselor
  • Bridgeport, CT
  • NPI 1215188826
  NPD tax ID
• Connecticut Renaissance, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Waterbury, CT
  • NPI 1700352721
  NPD tax ID
• Connecticut Renaissance, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Bridgeport, CT
  • NPI 1720130362
  NPD tax ID

Locations

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

{
    "created_epoch": "1353369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357084800000",
    "number": "1194069708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 FAIRFIELD AVE",
            "address_2": "SUITE 701",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066046014",
            "telephone_number": "203-336-5225",
            "fax_number": "203-336-2851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1126 MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066044404",
            "telephone_number": "203-333-2040",
            "fax_number": "203-333-2152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT RENAISSANCE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-20",
        "last_updated": "2013-01-02",
        "status": "A",
        "authorized_official_last_name": "RIKER",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "20333652258",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "CT",
            "license": "0442",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "CT",
            "license": "0442",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Katharine Bernadette Connolly, MS, PA-C

• Substance Use Disorder Rehabilitation Clinic/Center in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2013; 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.