| Legion Avenue Clinic | |
|
495 Congress Ave New Haven CT 06519-1312 | |
| (203) 781-4740 | |
| (203) 781-4751 |
| Full Name | Legion Avenue Clinic |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 495 Congress Ave, New Haven, Connecticut |
| Authorized Official Name and Position | Lynn M Madden (PRESIDENT/CEO) |
| Authorized Official Contact | 2037814600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Legion Avenue Clinic 1 Long Wharf Dr Suite 321 New Haven CT 06511-5991 Ph: (203) 781-4600 | Legion Avenue Clinic 495 Congress Ave New Haven CT 06519-1312 Ph: (203) 781-4740 |
| NPI Number | 1649405887 |
|---|---|
| Provider Enumeration Date | 05/18/2009 |
| Last Update Date | 02/21/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649405887 | NPI | - | NPPES |
| 008022622 | Other | CT | LEGION/MEDICAID/MH |
| 008037391 | Other | CT | SHACKELL MEDICAID |
| 008050785 | Other | CT | DROZD MEDICAID |
| 008070113 | Medicaid | CT | |
| 001302497 | Other | CT | SHI MEDICAID |
| 008003745 | Other | CT | DESROSIERS MEDICAID |
| 001423136 | Other | CT | TETRAULT MEDICAID |
| 008069472 | Other | CT | POTWARDOWSKI MEDICAID |
| 008038052 | Other | CT | NODELMAN MEDICAID |
| 008038037 | Other | CT | EGGERT MEDICAID |
| 008045323 | Other | CT | GARCIA MEDICAID |
| 008066293 | Other | CT | MARDAM BEY MEDICAID |
| 008061961 | Other | CT | SMALL-OIE MEDICAID |
| 001340132 | Other | CT | SAVAGE MEDICAID |
| 008038053 | Other | CT | ROEHRICH MEDICAID |
| 008048393 | Other | CT | BARRY MEDICAID |
| 008050854 | Other | CT | BUTNER MEDICAID |
| 008053091 | Other | CT | BUTNER MEDICAID |
| 001218107 | Other | CT | SCHOTTENFELD MEDICAID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 0476 (Connecticut) | Primary |
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