Concrete Interventions and Support Services PLLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

CONCRETE INTERVENTIONS AND SUPPORT SERVICES PLLC

Practice address

55 Great Meadow LN
Avon, CT 06001-4549

Phone

(860) 995-7155

NPI assigned

Dec 6, 2021

Organization subpart

No

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

Authorized official

Name

Gina Rose, LCSW

Title

Owner

Phone

(860) 995-7155

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1638748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638748800000",
    "number": "1235897356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 GREAT MEADOW LN",
            "city": "AVON",
            "state": "CT",
            "postal_code": "060014549",
            "telephone_number": "860-995-7155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 GREAT MEADOW LN",
            "city": "AVON",
            "state": "CT",
            "postal_code": "060014549",
            "telephone_number": "860-995-7155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONCRETE INTERVENTIONS AND SUPPORT SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-06",
        "last_updated": "2021-12-06",
        "certification_date": "2021-12-06",
        "status": "A",
        "authorized_official_last_name": "ROSE",
        "authorized_official_first_name": "GINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-995-7155",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Maureen Connors
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• Adult Mental Health Clinic/Center in Avon, CT
• Providers in Avon, CT by specialty
• Adult Mental Health Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2021; 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.