Basic Information
| Provider Information | |||||||||
| NPI: | 1568998706 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CATHOLIC CHARITIES OF FAIRFIELD COUNTY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 405 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068104710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037434412 | ||||||||
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| Practice Location | |||||||||
| Address1: | 120 EAST AVE | ||||||||
| Address2: | |||||||||
| City: | NORWALK | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068515703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037059711 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2017 | ||||||||
| LastUpdateDate: | 05/09/2017 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | GLENDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PATIENTS ACCOUNT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2037434412 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 104100000 | CT | Y | Agencies | Community/Behavioral Health |
No ID Information.