CONNECTICUT JUNIOR REPUBLIC ASSOCIATION INC. NPI 1174644926

NPI Information

  • NPI: 1174644926
  • Provider Name: CONNECTICUT JUNIOR REPUBLIC ASSOCIATION, INC.
  • Classification: Clinic/Center - 261QM0855X
  • Specialization: Adolescent and Children Mental Health
  • Entity Type: Organization
  • CLIA Number: 07D2311577
  • Address: 80 PROSPECT ST
    WATERBURY, CT
    ZIP 06702
  • Phone: (203) 757-9939

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NPI Details

CONNECTICUT JUNIOR REPUBLIC ASSOCIATION, INC. is an adolescent and children mental health clinic center in Waterbury, CT. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. CONNECTICUT JUNIOR REPUBLIC ASSOCIATION, INC. NPI is 1174644926. The provider is registered as an organization entity type.

The provider's business location address is:

80 PROSPECT ST
WATERBURY, CT
ZIP 06702-327
Phone: (203) 757-9939

The provider's authorized official is John F Boyd .
The authorized official title is Executive Director and has the following contact phone number (860) 567-9423.

The CLIA number assigned to this NPI record is 07D2311577 - school/student health service with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/2/2007 and was last updated on 6/30/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM0855XClinic/CenterAdolescent and Children Mental HealthSA0189CONNECTICUTYes

What is NPI?

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This page was last updated on: 11/21/2025

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