NPIMap

Organization Active NPI

Child and Family Agency of Southeastern Connecticut, Inc.

  • Clinic/Center
  • Groton, CT
National Provider Identifier
1417977620
Registry record updated Jun 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
CHILD AND FAMILY AGENCY OF SOUTHEASTERN CONNECTICUT, INC.
Practice address
1 Harry Day Dr
Groton, CT 06340-4368
Phone
(860) 445-2133
Fax
(860) 445-2133
NPI assigned
Jul 20, 2006
Last updated
Jun 20, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2019

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

Authorized official

Name
Lisa Baxter
Title
Chief Financial and Admin Officer
Phone
(860) 443-2896

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

1 Harry Day Dr
Groton, CT 06340-4368

Mailing address

255 Hempstead Street
New London, CT 06320

Other identifiers 1

IdentifierTypeStateIssuer
004215556MedicaidCT

National Provider Directory

National Provider Directory
Tax ID family
The Community Bridge Clinic37 organizations share this tax ID, including this one

Other organizations with this tax ID 36

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

View all 36

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560988800000",
    "number": "1417977620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 HEMPSTEAD STREET",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "06320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HARRY DAY DR",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063404368",
            "telephone_number": "860-445-2133",
            "fax_number": "860-445-2133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILD AND FAMILY AGENCY OF SOUTHEASTERN CONNECTICUT, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2019-06-20",
        "status": "A",
        "authorized_official_last_name": "BAXTER",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "CHIEF FINANCIAL AND ADMIN OFFICER",
        "authorized_official_telephone_number": "860-443-2896"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004215556",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Groton, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2019; 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.