Provider Demographics
NPI:1518374859
Name:YOUTH CONTINUUM
Entity type:Organization
Organization Name:YOUTH CONTINUUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SASHA
Authorized Official - Middle Name:MARISSA
Authorized Official - Last Name:GELBAND
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-562-3396
Mailing Address - Street 1:24 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-4317
Mailing Address - Country:US
Mailing Address - Phone:203-562-3396
Mailing Address - Fax:203-867-5888
Practice Address - Street 1:705 ROBERT FROST DR
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-5838
Practice Address - Country:US
Practice Address - Phone:203-468-1173
Practice Address - Fax:203-468-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-18
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT108295302251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT8694OtherCT STATE LICENSE