Provider Demographics
NPI:1194746982
Name:JEWISH FAMILY SERVICES OF GREATER HARTFORD, INC
Entity type:Organization
Organization Name:JEWISH FAMILY SERVICES OF GREATER HARTFORD, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OLDER ADULTS CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MITTENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-236-1927
Mailing Address - Street 1:333 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-1544
Mailing Address - Country:US
Mailing Address - Phone:860-236-1927
Mailing Address - Fax:860-236-6483
Practice Address - Street 1:333 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-1544
Practice Address - Country:US
Practice Address - Phone:860-236-1927
Practice Address - Fax:860-236-6483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0052731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC01423Medicare ID - Type UnspecifiedOUTPATIENT MENTAL HEALTH