07D0882210 CLIA NUMBER - GWENDOLYN BATCHELDER INFIRMARY LOOMIS CHAFFEE SCHOOL, THE

Laboratory Demographics

CLIA Number: 07D0882210

Facility Name: GWENDOLYN BATCHELDER INFIRMARY LOOMIS CHAFFEE SCHOOL, THE

Facility Address:
4 BATCHELDER ROAD
WINDSOR, CT
ZIP 06095
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Facility Phone Number: 860 688-4934

Facility Type: School/Student Health Service

Certificate Type: Waiver

NPI Number: 1699444091

Taxonomy: 101Y00000X - Counselor
A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.

CLIA Record

Field Name	Field Value
CLIA Number	07D0882210
LAB Type	School/Student Health Service
Facility Name	GWENDOLYN BATCHELDER INFIRMARY LOOMIS CHAFFEE SCHOOL, THE
Street	4 BATCHELDER ROAD
City	WINDSOR
State	CT
ZIP	06095
Phone	860 688-4934
CertificateType	4
CertificateEffectiveDate	11/7/2022
CertificateExpirationDate	11/6/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024