| Connecticut Junior Republic Association, Inc. | |
|
80 Prospect St Waterbury CT 06702-1327 | |
| (203) 757-9939 | |
| Not Available |
| Full Name | Connecticut Junior Republic Association, Inc. |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 80 Prospect St, Waterbury, Connecticut |
| Authorized Official Name and Position | John F Boyd (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8605679423 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Connecticut Junior Republic Association, Inc. 550 Goshen Road Po Box 161 Litchfield CT 06759-0161 Ph: (860) 567-9423 | Connecticut Junior Republic Association, Inc. 80 Prospect St Waterbury CT 06702-1327 Ph: (203) 757-9939 |
| NPI Number | 1174644926 |
|---|---|
| Provider Enumeration Date | 04/02/2007 |
| Last Update Date | 06/30/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174644926 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | SA0189 (Connecticut) | Primary |
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