Provider Demographics
NPI:1306504220
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:CFO
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 1:255 HEMPSTEAD ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-6290
Mailing Address - Country:US
Mailing Address - Phone:860-443-2896
Mailing Address - Fax:860-442-5909
Practice Address - Street 1:160 FISHTOWN RD
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-2012
Practice Address - Country:US
Practice Address - Phone:860-980-8330
Practice Address - Fax:860-980-8330
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILD AND FAMILY AGENCY OF SOUTHEASTERN CONNECTICUT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1137OtherDPH