NPIMap

Organization Active NPI

Connecticut Renaissance, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Norwalk, CT
National Provider Identifier
1265449359
Registry record updated Jun 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
CONNECTICUT RENAISSANCE, INC
Practice address
4 Byington PL
Norwalk, CT 06850-3309
Phone
(203) 866-2541
Fax
(203) 854-5682
NPI assigned
Aug 2, 2006
Organization subpart
Yes
Parent organization
CONNECTICUT RENAISSANCE, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 30, 2022

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

Authorized official

Name
Dawn Patston, LMFTNPI 1508137381
Title
Coo
Phone
(203) 336-5225

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X

Addresses

Primary practice location

4 Byington PL
Norwalk, CT 06850-3309

Mailing address

1 Waterview Dr Ste 202
Shelton, CT 06484-4368
Phone (203) 336-5225

Other identifiers 1

IdentifierTypeStateIssuer
004138914MedicaidCT

Other names 1

  • CT Renaissance Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050222000611 CT Part B Supplier - Clinic/Group Practice 0941253728 Receives reassigned benefits from 8 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Norwalk, CT; Shelton, CT; Waterbury, CT

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
07D2146602CT Renaissance, Inc4 Byington Place, Norwalk, CT 06850Certificate of waiverApr 2, 2028

National Provider Directory

National Provider Directory
Tax ID family
Connecticut Renaissance Inc8 organizations share this tax ID, including this one
Part of
Connecticut Renaissance Inc

Other organizations with this tax ID 7

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

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656547200000",
    "number": "1265449359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 WATERVIEW DR STE 202",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064844368",
            "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": "4 BYINGTON PL",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068503309",
            "telephone_number": "203-866-2541",
            "fax_number": "203-854-5682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT RENAISSANCE, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CONNECTICUT RENAISSANCE, INC",
        "enumeration_date": "2006-08-02",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "status": "A",
        "authorized_official_last_name": "PATSTON",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "203-336-5225",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004138914",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CT Renaissance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Norwalk, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.