Provider Demographics
NPI:1396159786
Name:SELF INJURY AWARENESS NETWORK, INC.
Entity type:Organization
Organization Name:SELF INJURY AWARENESS NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:BICKING
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MPA
Authorized Official - Phone:860-598-0018
Mailing Address - Street 1:18-20 TRINITY STREET
Mailing Address - Street 2:C/O CT ASIAN PACIFIC AMERICAN COMMISSION
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106
Mailing Address - Country:US
Mailing Address - Phone:860-598-0018
Mailing Address - Fax:
Practice Address - Street 1:18-20 TRINITY ST
Practice Address - Street 2:C/O CT ASIAN PACIFIC AMERICAN COMMISSION
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-1600
Practice Address - Country:US
Practice Address - Phone:860-598-0018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health