NPIMap

Organization Active NPI

Community Child Guidance Clinic, Inc.

  • Adolescent and Children Mental Health Clinic/Center
  • Manchester, CT
National Provider Identifier
1780730267
Registry record updated May 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
OPCC-14 Issued in CT
Legal business name
COMMUNITY CHILD GUIDANCE CLINIC, INC.
Practice address
317 N Main St
Manchester, CT 06042-2007
Phone
(860) 643-2101
Fax
(860) 645-1470
NPI assigned
Jan 26, 2007
Last updated
May 3, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 3, 2013

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

Authorized official

Name
Mr. Clifford Johnson, LCSWNPI 1952630519
Title
Executive Director
Phone
(860) 643-2101

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 0238 CT
Adolescent and Children Mental Health Clinic/Center 261QM0855X OPCC-14 CT Primary

Addresses

Primary practice location

317 N Main St
Manchester, CT 06042-2007

Mailing address

317 N Main St
Manchester, CT 06042-2007
Phone (860) 643-2101

Other identifiers 1

IdentifierTypeStateIssuer
004039277MedicaidCT

National Provider Directory

National Provider Directory

Locations

317 N Main St
Manchester, CT 06042
Phone (860) 643-2101

Practitioners & affiliated clinicians

Practitioners 35

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 35

NPI Registry JSON

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367539200000",
    "number": "1780730267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "317 N MAIN ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060422007",
            "telephone_number": "860-643-2101",
            "fax_number": "860-645-1470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "317 N MAIN ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060422007",
            "telephone_number": "860-643-2101",
            "fax_number": "860-645-1470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CHILD GUIDANCE CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2013-05-03",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "CLIFFORD",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "860-643-2101",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CT",
            "license": "0238",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "CT",
            "license": "OPCC-14",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004039277",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2013; 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.