Provider Demographics
NPI:1285074484
Name:CAPITOL REGION EDUCATION COUNCIL
Entity type:Organization
Organization Name:CAPITOL REGION EDUCATION COUNCIL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLANAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:860-509-3780
Mailing Address - Street 1:123 PROGRESS DR
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-2450
Mailing Address - Country:US
Mailing Address - Phone:860-529-4260
Mailing Address - Fax:860-257-8500
Practice Address - Street 1:123 PROGRESS DR
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-2450
Practice Address - Country:US
Practice Address - Phone:860-529-4260
Practice Address - Fax:860-257-8500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3120869962252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008077494Medicaid