NPIMap

Organization Active NPI

Family Intervention Center, Inc

  • Clinic/Center
  • Waterbury, CT
National Provider Identifier
1598764474
Registry record updated Oct 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
0390 Issued in CT
Legal business name
FAMILY INTERVENTION CENTER, INC
Practice address
22 Chase River Rd
Waterbury, CT 06704-1408
Phone
(203) 753-2153
Fax
(203) 756-6032
NPI assigned
Jul 21, 2005
Last updated
Oct 2, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2023

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

Authorized official

Name
Mr. Joseph E. Futschik, L.C.S.W.NPI 1225086853
Title
President
Phone
(203) 753-2153

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 0390 CT
Clinic/Center 261Q00000X 0390 CT Primary
Adult Mental Health Clinic/Center 261QM0850X 0471 CT

Addresses

Primary practice location

22 Chase River Rd
Waterbury, CT 06704-1408

Mailing address

22 Chase River Rd
Waterbury, CT 06704-1408
Phone (203) 753-2153

Other identifiers 2

IdentifierTypeStateIssuer
140001006CT01OtherCTANTHEM
004065439MedicaidCT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080826000450 CT Part B Supplier - Clinic/Group Practice 5193890135 Receives reassigned benefits from 4 practitioners
Practice locations: Waterbury, CT

National Provider Directory

National Provider Directory

Locations

1875 Thomaston Ave
Waterbury, CT 06704
Phone (203) 753-2153

22 Chase River Rd
Waterbury, CT 06704
Phone (203) 753-2153

51 Lakeside Blvd E
Waterbury, CT 06708
Phone (203) 753-2153

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1121904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696204800000",
    "number": "1598764474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 CHASE RIVER RD",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067041408",
            "telephone_number": "203-753-2153",
            "fax_number": "203-756-6032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 CHASE RIVER RD",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067041408",
            "telephone_number": "203-753-2153",
            "fax_number": "203-756-6032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY INTERVENTION CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-21",
        "last_updated": "2023-10-02",
        "certification_date": "2023-10-02",
        "status": "A",
        "authorized_official_last_name": "FUTSCHIK",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-753-2153",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "L.C.S.W."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CT",
            "license": "0390",
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CT",
            "license": "0390",
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "CT",
            "license": "0471",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "140001006CT01",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004065439",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterbury, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.