Basic Information
| Provider Information | |||||||||
| NPI: | 1114015211 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEWTOWN YOUTH AND FAMILY SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 BERKSHIRE RD. | ||||||||
| Address2: | NEWTOWN YOUTH AND FAMILY SERVICES | ||||||||
| City: | SANDY HOOK | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034268103 | ||||||||
| FaxNumber: | 2032704338 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 BERKSHIRE RD. | ||||||||
| Address2: | NEWTOWN YOUTH AND FAMILY SERVICES | ||||||||
| City: | SANDY HOOK | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034268103 | ||||||||
| FaxNumber: | 2032704338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 12/07/2018 | ||||||||
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| AuthorizedOfficialLastName: | FOSTER | ||||||||
| AuthorizedOfficialFirstName: | CANDICE | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2034268103 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | OPCC-27 | CT | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM0801X | C-0254 | CT | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | ANC1319 | 01 | CT | OXFORD PROVIDER PIN | OTHER | 77ABH0020CT01 | 01 | CT | ANTHEM BEHAVIORAL HEALTH | OTHER | 248294 | 01 | CT | MHN | OTHER | 00412586200 | 05 | CT | MEDICAID |