| Organization Name: | CENTRAL CONNECTICUT BEHAVIORAL HEALTH LLC |
| NPI Number: | 1043666480 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RICHARD FRANK COMSHAW (CHIEF EXECUTIVE OFFICER) |
| Mailing Address: | 2275 Silas Deane Hwy Rocky Hill |
| State: | CT US |
| Postal Code: | 060672329 |
| Phone Number: | 8603015670 |
| Fax Number: | |
| NPI Enumeration Date: | 05/04/2016 |
| NPI Last Update Date: | 05/11/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | 0001702 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |