07D2134629 CLIA NUMBER - STATE OF CONNECTICUT DBA-WESTERN CT MENTAL HEALTH NETWORK

Laboratory Demographics

CLIA Number: 07D2134629

Facility Name: STATE OF CONNECTICUT DBA-WESTERN CT MENTAL HEALTH NETWORK

Facility Address:
95 THOMASTON AVE
WATERBURY, CT
ZIP 06702
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Facility Phone Number: 203 805-6415

Facility Type: Other - COMMUNITY MENTAL HEALTH

Certificate Type: Waiver

NPI Number: 1841225489

Taxonomy: 261QM0850X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults.

CLIA Record

Field Name	Field Value
CLIA Number	07D2134629
LAB Type	Other - COMMUNITY MENTAL HEALTH
Facility Name	STATE OF CONNECTICUT DBA-WESTERN CT MENTAL HEALTH NETWORK
Street	95 THOMASTON AVE
City	WATERBURY
State	CT
ZIP	06702
Phone	203 805-6415
CertificateType	4
CertificateEffectiveDate	8/7/2023
CertificateExpirationDate	8/6/2025
FacilityType	Waiver

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