| Family Intervention Center, Inc | |
|
22 Chase River Rd Waterbury CT 06704-1408 | |
| (203) 753-2153 | |
| (203) 756-6032 |
| Full Name | Family Intervention Center, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 22 Chase River Rd, Waterbury, Connecticut |
| Authorized Official Name and Position | Joseph E. Futschik (PRESIDENT) |
| Authorized Official Contact | 2037532153 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Intervention Center, Inc 22 Chase River Rd Waterbury CT 06704-1408 Ph: (203) 753-2153 | Family Intervention Center, Inc 22 Chase River Rd Waterbury CT 06704-1408 Ph: (203) 753-2153 |
| NPI Number | 1598764474 |
|---|---|
| Provider Enumeration Date | 07/21/2005 |
| Last Update Date | 10/02/2023 |
| Certification Date | 10/02/2023 |
| Medicare PECOS PAC ID | 5193890135 |
|---|---|
| Medicare Enrollment ID | O20080826000450 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598764474 | NPI | - | NPPES |
| 140001006CT01 | Other | CT | ANTHEM |
| 004065439 | Medicaid | CT |
| Provider Name | Laurie A Duncan |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1912980145 PECOS PAC ID: 5597678862 Enrollment ID: I20031112000105 |
| Provider Name | Joseph E Futschik |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225086853 PECOS PAC ID: 1759458839 Enrollment ID: I20110216000788 |
| Provider Name | Lori Pelosi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649521352 PECOS PAC ID: 2668624578 Enrollment ID: I20121128000425 |
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