STATE OF CONNECTICUT NPI 1841225489

NPI Information

STATE OF CONNECTICUT is an adult 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 adults. STATE OF CONNECTICUT NPI is 1841225489. The provider is registered as an organization entity type.
The provider Is Doing Business As Western Connecticut Mental Health Network.

The provider's business location address is:

55 WEST MAIN STREET
SUITE 410 ROWLAND STATE GOVERNMENT CENTER
WATERBURY, CT
ZIP 06702
Phone: (203) 805-6403
Fax: (203) 805-6432

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 07D2134629 - other 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:

Other Identifiers

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

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