Provider Demographics
NPI:1154878619
Name:REGIONAL YOUNG MEN'S CHRISTIAN ASSOCIATION OF WESTERN CONNECTICUT, INC
Entity type:Organization
Organization Name:REGIONAL YOUNG MEN'S CHRISTIAN ASSOCIATION OF WESTERN CONNECTICUT, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MISZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-740-3432
Mailing Address - Street 1:241 FEDERAL ROAD
Mailing Address - Street 2:UNIT B21
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804
Mailing Address - Country:US
Mailing Address - Phone:203-740-3432
Mailing Address - Fax:203-775-8350
Practice Address - Street 1:241 FEDERAL ROAD
Practice Address - Street 2:UNIT B21
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804
Practice Address - Country:US
Practice Address - Phone:203-740-3432
Practice Address - Fax:203-775-8350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty