1114015211 NPI number — NEWTOWN YOUTH AND FAMILY SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114015211 NPI number — NEWTOWN YOUTH AND FAMILY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEWTOWN YOUTH AND FAMILY SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114015211
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 BERKSHIRE RD.
Provider Second Line Business Mailing Address:
NEWTOWN YOUTH AND FAMILY SERVICES
Provider Business Mailing Address City Name:
SANDY HOOK
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06482
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-426-8103
Provider Business Mailing Address Fax Number:
203-270-4338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 BERKSHIRE RD.
Provider Second Line Business Practice Location Address:
NEWTOWN YOUTH AND FAMILY SERVICES
Provider Business Practice Location Address City Name:
SANDY HOOK
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-426-8103
Provider Business Practice Location Address Fax Number:
203-270-4338
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FOSTER
Authorized Official First Name:
CANDICE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
203-426-8103

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  C-0254 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0801X , with the licence number: OPCC-27 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ANC1319 . This is a "OXFORD PROVIDER PIN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 77ABH0020CT01 . This is a "ANTHEM BEHAVIORAL HEALTH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 248294 . This is a "MHN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 00412586200 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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