NPIMap

Organization Active NPI

Child and Family Agency of Southeastern Connecticut, Inc.

  • Adolescent and Children Mental Health Clinic/Center
  • New London, CT
National Provider Identifier
1780108399
Registry record updated Jun 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
CHILD AND FAMILY AGENCY OF SOUTHEASTERN CONNECTICUT, INC.
Practice address
490 Jefferson Ave
New London, CT 06320-2525
Phone
(860) 437-6400
Fax
(860) 701-3771
NPI assigned
Jul 26, 2017
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
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

490 Jefferson Ave
New London, CT 06320-2525

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
0146OtherCTDPH

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

NPI Registry JSON

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

{
    "created_epoch": "1501027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560988800000",
    "number": "1780108399",
    "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": "860-443-2896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "490 JEFFERSON AVE",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063202525",
            "telephone_number": "860-437-6400",
            "fax_number": "860-701-3771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILD AND FAMILY AGENCY OF SOUTHEASTERN CONNECTICUT, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-26",
        "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": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DPH",
            "identifier": "0146",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New London, 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.