Provider Demographics
NPI:1992096887
Name:HARTFORD GAY & LESBIAN HEALTH COLLECTIVE
Entity type:Organization
Organization Name:HARTFORD GAY & LESBIAN HEALTH COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ESTABROOK
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:860-278-4163
Mailing Address - Street 1:1841 BROAD ST.
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114-2094
Mailing Address - Country:US
Mailing Address - Phone:860-278-4163
Mailing Address - Fax:860-278-5995
Practice Address - Street 1:1841 BROAD ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-1780
Practice Address - Country:US
Practice Address - Phone:860-278-4163
Practice Address - Fax:860-278-5995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001588101YM0800X
CT007780122300000X
CT002904124Q00000X
CTR49289163W00000X
CT000166171100000X
CT031112207RI0200X
CT0302261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty