1871982967 NPI number — BREAKTHROUGH CLINICAL SERVICES

Table of content: EMILY BRYANT CORRIGAN LCSW (NPI 1508982620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871982967 NPI number — BREAKTHROUGH CLINICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BREAKTHROUGH CLINICAL SERVICES
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:
1871982967
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
72 BRIARWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINDSOR
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06095-3937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-597-7504
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
360 BLOOMFIELD AVE
Provider Second Line Business Practice Location Address:
STE 301
Provider Business Practice Location Address City Name:
WINDSOR
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06095-2700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-597-7504
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/13/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SAMUEL
Authorized Official First Name:
VELANDA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
860-597-7504

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  008665 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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