Basic Information
| Provider Information | |||||||||
| NPI: | 1346550977 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEW ENGLAND CENTER FOR C.B.T. & PSYCHIATRY | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NEW ENGLAND BEHAVIORAL HEALTH | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 NATIONAL DR | ||||||||
| Address2: | |||||||||
| City: | GLASTONBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060334371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604305515 | ||||||||
| FaxNumber: | 8604309754 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 NATIONAL DR | ||||||||
| Address2: | |||||||||
| City: | GLASTONBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060334371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604305515 | ||||||||
| FaxNumber: | 8604309754 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2010 | ||||||||
| LastUpdateDate: | 03/23/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CORDIER | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | ANDREW | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8604305515 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PHD LCPC | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 001420 | CT | N | Agencies | Community/Behavioral Health | 261QM0855X | 001420 | CT | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 261QM0850X | 001420 | CT | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 101YP2500X | 001420 | CT | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional | 103TB0200X | 001420 | CT | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 261QM0801X | 001420 | CT | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.