Provider Demographics
NPI:1346337748
Name:FAMILY SERVICES OF CENTRAL CONNECTICUT, INC.
Entity type:Organization
Organization Name:FAMILY SERVICES OF CENTRAL CONNECTICUT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MURADIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPA
Authorized Official - Phone:860-826-1358
Mailing Address - Street 1:92 VINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1433
Mailing Address - Country:US
Mailing Address - Phone:860-223-9291
Mailing Address - Fax:860-223-3111
Practice Address - Street 1:1890 DIXWELL AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-3122
Practice Address - Country:US
Practice Address - Phone:203-288-7484
Practice Address - Fax:203-288-7485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0352261QM0801X
CT0338261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Not Answered261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT192831OtherMANAGED HEALTH NETWORK
CT77ABH0021CT01OtherANTHEM
CTCTGA000438 B751773OtherSAGA GRP
CTANC1482OtherOXFORD HEALTH PLANS
CTC 01688Medicare ID - Type UnspecifiedMEDICARE