1063437895 NPI number — TOWN OF BRANFORD

Table of content: (NPI 1063437895)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063437895 NPI number — TOWN OF BRANFORD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF BRANFORD
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:
BRANFORD COUNSELING CENTER
Provider Other Organization Name Type Code:
3
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:
1063437895
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
342 HARBOR STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRANFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-481-4248
Provider Business Mailing Address Fax Number:
203-483-7727

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
342 HARBOR STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRANFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-481-4248
Provider Business Practice Location Address Fax Number:
203-483-7727
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CIMINO
Authorized Official First Name:
PETER
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
203-481-4248

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  002668 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 005435 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 1942449186 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 014248 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X , with the licence number: C01490 , 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: C0149 , 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)

  • Identifier: C-0149 . This is a "STATE LIC. NUMBER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: ANC1650 . This is a "OXFORD INS. GRP NO." identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 142474 . This is a "VALUE OPTS. B.H. ID NO." identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004051884 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 191065 . This is a "M.H.N./H.M.C. GRP NO." identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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