NPIMap

Organization Active NPI

Child and Family Agency of Southeastern Connecticut, Inc.

  • Clinic/Center
  • Mystic, CT
National Provider Identifier
1467097667
Registry record updated Nov 12, 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
204 Mistuxet Ave
Mystic, CT 06355-3009
Phone
(860) 536-8613
NPI assigned
Nov 12, 2019
Last updated
Nov 12, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2019

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

Authorized official

Name
Lisa Baxter
Title
Cfao
Phone
(860) 443-2896

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

204 Mistuxet Ave
Mystic, CT 06355-3009

Mailing address

255 Hempstead St
New London, CT 06320-6204
Phone (860) 443-2896

Other names 1

  • Stonington Middle School Based Health Center Other name

National Provider Directory

National Provider Directory
Tax ID family
Child Family Agency of Sou37 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

Locations

204 Mistuxet Ave
Mystic, CT 06355
Phone (860) 536-8613

Practitioners & affiliated clinicians

Practitioners 2

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": "1573516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573516800000",
    "number": "1467097667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 HEMPSTEAD ST",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063206204",
            "telephone_number": "860-443-2896",
            "fax_number": "860-442-5909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 MISTUXET AVE",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063553009",
            "telephone_number": "860-536-8613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILD AND FAMILY AGENCY OF SOUTHEASTERN CONNECTICUT, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-12",
        "last_updated": "2019-11-12",
        "status": "A",
        "authorized_official_last_name": "BAXTER",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "CFAO",
        "authorized_official_telephone_number": "860-443-2896"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stonington Middle School Based Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mystic, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 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.