1346550977 NPI number — NEW ENGLAND CENTER FOR C.B.T. & PSYCHIATRY

Table of content: (NPI 1346550977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346550977 NPI number — NEW ENGLAND CENTER FOR C.B.T. & PSYCHIATRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW ENGLAND CENTER FOR C.B.T. & PSYCHIATRY
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:
NEW ENGLAND BEHAVIORAL HEALTH
Provider Other Organization Name Type Code:
4
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:
1346550977
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 NATIONAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLASTONBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06033-4371
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-430-5515
Provider Business Mailing Address Fax Number:
860-430-9754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 NATIONAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLASTONBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06033-4371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-430-5515
Provider Business Practice Location Address Fax Number:
860-430-9754
Provider Enumeration Date:
10/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CORDIER
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
ANDREW
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
860-430-5515

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  001420 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TB0200X , with the licence number: 001420 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 001420 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 001420 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0850X , with the licence number: 001420 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X , with the licence number: 001420 , 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)





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