Child and Family Agency of Southeastern Connecticut, Inc.
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Groton, CT
NPI 1932240504 · NPPES record last updated Jun 20, 2019
Key facts
- NPI
- 1932240504
- 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
- 591 Poquonnock Rd
Groton, CT 06340-4571 - Phone
- (860) 449-8217
- Fax
- (860) 449-8323
- 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 7
-
Tammy F. Bogue, MFT
-
Jeannine Cleaver, LCSW
-
Rachel K Daley, BS
-
Theresa M Ramponi, APRN
-
Brittany Sanchez, LPC
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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes |
Addresses
Primary practice location
591 Poquonnock Rd
Groton, CT 06340-4571
Mailing address
255 Hempstead St
New London, CT 06320-6204
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 007228736 | Medicaid | CT |
Other providers in Groton, CT
- Child and Family Agency of Southeastern Connecticut, Inc.
- Child and Family Agency of Southeastern Connecticut, Inc.
- Child and Family Agency of Southeastern Connecticut, Inc.
- Child and Family Agency of Southeastern Connecticut, Inc.
- Child and Family Agency of Southeastern Connecticut, Inc.
- Kajonwud Shane Chongulia
- Christian Counseling Center of SE CT, Inc.
- Kaileah Christie-Fogg
- Corie Citron
- Claim Path Connecticut, LLC
All providers in Groton, 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 Jun 20, 2019. 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.