Child and Family Agency of Southeastern Connecticut, Inc.
Organization Active NPI Clinic/Center · Mystic, CT
NPI 1467097667 · NPPES record last updated Nov 12, 2019
Key facts
- NPI
- 1467097667
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 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
- Organization subpart
- No
Authorized official
- Name
- Lisa Baxter
- Title
- Cfao
- Phone
- (860) 443-2896
Corporate family (same tax ID) 36
Practitioners 2
-
Craig A Holch, MA
-
Lindsey Watkins, APRN
National Provider Directory
- Tax ID family
- Child Family Agency of Sou
Locations
204 Mistuxet Ave
Mystic, CT 06355
Phone (860) 536-8613
255 Hempstead St
New London, CT 06320
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1065 | Other | CT | SCHOOL BASED HEALTH CENTER |
Other names
- Stonington Middle School Based Health Center
Other providers in Mystic, CT
- Jason T Cerro
- Wade Lindsay Chartier
- Curt Ira Cheslog
- Child and Family Agency of Southeastern Connecticut Inc.
- Child and Family Agency of Southeastern Connecticut, Inc.
- Child and Family Agency of Southeastern Connecticut, Inc.
- Sungsil Cho
- Katieanne P Christian
- Christopher Level Inc
- Kathrine Lynn Clarke
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 12, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.