STATE OF CONNECTICUT NPI 1720013360

NPI Information

NPI: 1720013360
Provider Name: STATE OF CONNECTICUT

Doing Business As: SOUTHWEST CONNECTICUT MENTAL HEALTH SYSTEM

Classification: Psychiatric Hospital - 283Q00000X
Entity Type: Organization

Address:
1635 CENTRAL AVE
BRIDGEPORT, CT
ZIP 06610
Phone: (203) 551-7660
Get Directions

STATE OF CONNECTICUT is a psychiatric hospital in Bridgeport, CT. The provider is an organization including a physical plant and personnel that provides multidisciplinary diagnostic and treatment mental health services to patients requiring the safety, security, and shelter of the inpatient or partial hospitalization settings. STATE OF CONNECTICUT NPI is 1720013360. The provider is registered as an organization entity type.
The provider Is Doing Business As Southwest Connecticut Mental Health System.

The provider's business location address is:

1635 CENTRAL AVE
BRIDGEPORT, CT
ZIP 06610
Phone: (203) 551-7660
Fax: (203) 551-7481

The provider's authorized official is Stephen A Dipietro .
The authorized official title is Chief Financial Officer and has the following contact phone number (860) 418-6923.

The CLIA number assigned to this NPI record is 07D0916305 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/12/2006 and was last updated on 3/16/2016.

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
1	283Q00000X	Psychiatric Hospital				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	004075651	MEDICAID	CONNECTICUT
2	004120060	MEDICAID	CONNECTICUT
3	C01001	MEDICARE ID-TYPE UNSPECIFIED	CONNECTICUT	FIRST COAST
4	004025607	MEDICAID	CONNECTICUT
5	074012	MEDICARE ID-TYPE UNSPECIFIED	CONNECTICUT	EMPIRE
6	004075669	MEDICAID	CONNECTICUT
7	004122925	MEDICAID	CONNECTICUT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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