CHILD AND FAMILY AGENCY OF SOUTHEASTERN CONNECTICUT, INC. (NPI# 1780108399) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780108399 |
| Entity Type | Organization |
| Organization Name | CHILD AND FAMILY AGENCY OF SOUTHEASTERN CONNECTICUT, INC. |
| Practice Address |
490 Jefferson Ave New London CT 06320-2525 |
| Mailing Address |
255 Hempstead St New London CT 06320-6204 |
| Practice Telephone | 8604376400 |
| Practice Fax Number | 8607013771 |
| Mailing Telephone | 8604432896 |
| Mailing Fax Number | 8604432896 |
| Enumeration Date | 2017-07-26 |
| Last Update Date | 2019-06-20 |
| Authorized Official Name | LISA BAXTER (CHIEF FINANCIAL AND ADMIN OFFICER) |
| Authorized Official Telephone | 8604432896 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | DPH | 0146 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609414176 | Child and Family Agency of Southeastern Connecticut, Inc. | Clinic/Center | 154 Toll Gate Rd, Groton, CT 06340-3444 | 2019-12-16 |
| 1053652651 | Child and Family Agency of Southeastern Connecticut, Inc. | Clinic/Center | 40 Field St, Pawcatuck, CT 06379-2186 | 2013-03-06 |
| 1962750539 | Child and Family Agency of Southeastern Connecticut, Inc. | Clinic/Center | 160 Fishtown Rd, Mystic, CT 06355-2012 | 2012-08-29 |
| 1881871168 | Child and Family Agency of Southeastern Connecticut, Inc. | Clinic/Center | 500 Poquonnock Rd, Groton, CT 06340-4568 | 2008-01-29 |
| 1043403942 | Child and Family Agency of Southeastern Connecticut, Inc. | Clinic/Center | 40 Shaw St, New London, CT 06320-4922 | 2007-08-23 |
| 1467468025 | Child and Family Agency of Southeastern Connecticut, Inc. | Clinic/Center | 101 Groton Long Point Rd, Groton, CT 06340-4861 | 2006-08-01 |
| 1013921048 | Child and Family Agency of Southeastern Connecticut, Inc. | Clinic/Center | 37 Beech Dr, New London, CT 06320-3003 | 2006-07-27 |
| 1881608834 | Child and Family Agency of Southeastern Connecticut, Inc. | Clinic/Center | 74 Grove St, New London, CT 06320-6515 | 2006-07-27 |
| 1669496048 | Child and Family Agency of Southeastern Connecticut, Inc. | Clinic/Center | 1 Bulkeley Pl, New London, CT 06320-6206 | 2006-07-27 |
| 1467476853 | Child and Family Agency of Southeastern Connecticut, Inc. | Clinic/Center | 7 Vauxhall St, New London, CT 06320-5711 | 2006-07-27 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | CHILD AND FAMILY AGENCY OF SOUTHEASTERN CONNECTICUT, INC. | 255 Hempstead St, New London, CT 06320-6204 |
| Street Address |
490 JEFFERSON AVE |
| City | NEW LONDON |
| State | CT |
| Zip Code | 06320-2525 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053325092 | Child and Family Agency of Southeastern Connecticut, Inc. | Clinic/Center | 490 Jefferson Ave, New London, CT 06320-2525 | 2006-07-27 |
| 1790274249 | Julie C Smith | Social Worker | 490 Jefferson Ave, New London, CT 06320-2525 | 2018-05-09 |
| 1033296280 | New London Public Schools | Student in an Organized Health Care Education/Training Program | 490 Jefferson Ave, New London High School, New London, CT 06320-2525 | 2006-11-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942824891 | Shilpi Jain | Physical Therapist | 31 Vauxhall Street, Beechwood Post Accute, Transitional, New London, CT 06320 | 2020-06-05 |
| 1174009641 | Catherine Hinojosa | Nurse Practitioner | 1 Shaws Cove, New London, CT 06320 | 2018-07-17 |
| 1043668320 | Cultivate & Grow Inc. | Counselor | 302 State St Suite 307, New London, CT 06320 | 2016-05-27 |
| 1295137263 | Jacqueline Durnell | Registered Nurse | 15 Mohegan Drive, Us Coast Guard Academy Regional Clinic, New London, CT 06320 | 2014-09-22 |
| 1922427541 | Corina Vendetto | Registered Nurse | 245 Shaw St., New London, CT 06320 | 2014-04-10 |
| 1912329962 | Janelle Posey-green | Social Worker | 302 State St., Suite 201, New London, CT 06320 | 2014-01-10 |
| 1750622692 | Cynthia Mitchell | Social Worker | 65b Michael Rd, New London, CT 06320 | 2013-03-01 |
| 1518254507 | Simon J Shapiro | Physical Medicine & Rehabilitation | 190 Howard Avenue, New London, CT 06320 | 2011-06-29 |
| 1184876708 | Jane P Genido-trujillo | Nurse Practitioner | 270 Mohegan Ave., Student Health Services, New London, CT 06320 | 2008-10-14 |
| 1932356284 | Gerard Joseph Ventura | Dentist | 21 Montauk Ave., Suite 102, New London, CT 06320 | 2008-08-19 |
| Find all providers in zip 06320 | ||||
| Taxonomy Code | 261QM0855X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adolescent and Children Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962926576 | Child and Family Agency of Southeastern Connecticut, Inc. | Clinic/Center | 36 Waller St, New London, CT 06320-5216 | 2017-07-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780195339 | Rachel Collins, Lpc | Clinic/Center | 410 State St Rm 1, North Haven, CT 06473-3149 | 2017-10-22 |
| 1376054148 | Joann Flynn LLC. | Clinic/Center | 3 Swanswood Ln, Old Lyme, CT 06371-1867 | 2017-10-19 |
| 1942723036 | Kellys Kids, Inc | Clinic/Center | 9 Spring Rd, Prospect, CT 06712-1522 | 2017-07-20 |
| 1295256840 | B.e.a.u.t.y, LLC | Clinic/Center | 824 Main St Ste F, Manchester, CT 06040-6048 | 2017-07-05 |
| 1518413442 | Community Partners In Action | Clinic/Center | 995 Sherman Ave, Hamden, CT 06514-1144 | 2016-08-31 |
| 1952760803 | Darbonshire, LLC | Clinic/Center | 304 Wahackme Rd, New Canaan, CT 06840-3936 | 2016-02-21 |
| 1760738025 | Psychologist Adriana L Gonzalez Phd Pllc | Clinic/Center | 85 Hillcrest Terrace, Meriden, CT 06450 | 2012-07-24 |
| 1497025035 | Ct Clinical Services, Inc. | Clinic/Center | 189 Orange St, New Haven, CT 06510-2014 | 2012-01-12 |
| 1093950032 | Yale Parenting and Child Conduct Clinic | Clinic/Center | 314 Prospect St, New Haven, CT 06511-2187 | 2008-12-04 |
| 1710185731 | Waterford Country School, Inc. | Clinic/Center | 78 Hunts Brook Rd, Quaker Hill, CT 06375-1009 | 2007-07-11 |
| Find all providers with the same taxonomy | ||||
| City | NEW LONDON |
| Zip Code | 06320 |
Please comment or provide details below to improve the information on CHILD AND FAMILY AGENCY OF SOUTHEASTERN CONNECTICUT, INC..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.