Child and Family Agency of Southeastern Connecticut, Inc.
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Westbrook, CT
NPI 1508907288 · NPPES record last updated Aug 23, 2022
Key facts
- NPI
- 1508907288
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- CHILD AND FAMILY AGENCY OF SOUTHEASTERN CONNECTICUT, INC.
- Practice address
- 4 Grove Beach Rd N Ste 2D
Westbrook, CT 06498-1656 - Phone
- (860) 437-4550
- NPI assigned
- Feb 8, 2007
- Organization subpart
- No
Authorized official
- Name
- Lisa Baxter
- Title
- Chief Financial and Admin Officer
- Phone
- (860) 443-2896
Other NPIs on the same Medicare enrollment 2
Corporate family (same tax ID) 36
Practitioners 6
-
Patricia Elliott, LCSW
-
Sarah Fedorchuck, LCSW
-
Sara Diane Lambert, APRN
-
Danielle Morgan, APRN
-
Maegan Renshaw, LCSW
-
Cathiann Velez, LMSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190628000228 | CT | Part B Supplier - Clinic/Group Practice | 2163756982 |
Receives reassigned benefits from 22 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Groton, CT; New London, CT; Westbrook, CT |
National Provider Directory
- Tax ID family
- Child Family Agency of Sou
Locations
7 Vauxhall St
New London, CT 06320
Phone (860) 442-2797
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes |
Addresses
Primary practice location
4 Grove Beach Rd N Ste 2D
Westbrook, CT 06498-1656
Mailing address
255 Hempstead St
New London, CT 06320-6204
Phone (860) 443-2896
Other practice location 1
190 Westbrook Rd
Essex, CT 06426-1518
Phone (860) 767-0147
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 007228738 | Medicaid | CT |
Other providers in Westbrook, CT
- Sharon Rose Cappella
- Catherine Jellie, LCSW LLC
- Colleen R Chappell
- Craig Chatfied
- Child and Family Agency of Southeastern Connecticut, Inc.
- Anthony P Ciaburri
- Lara Ann Colabelli
- Alexandra Cristello
- Joanna Crowell
- Christopher S Curdo
All providers in Westbrook, CT · Mental Health Clinic/Center (Including Community Mental Health Center) in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 23, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.