Provider Demographics
NPI:1093428252
Name:CHILD AND FAMILY AGENCY OF SOUTHEASTERN CONNECTICUT, INC.
Entity type:Organization
Organization Name:CHILD AND FAMILY AGENCY OF SOUTHEASTERN CONNECTICUT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFAO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-443-2896
Mailing Address - Street 1:PO BOX 120
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-0120
Mailing Address - Country:US
Mailing Address - Phone:860-437-4550
Mailing Address - Fax:860-661-4262
Practice Address - Street 1:4 GROVE BEACH RD N STE 2D
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:CT
Practice Address - Zip Code:06498-1656
Practice Address - Country:US
Practice Address - Phone:860-437-4550
Practice Address - Fax:860-661-4262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center