Provider Demographics
NPI:1780120063
Name:GREATER NEW HAVEN COUNSELING AND FAMILY THERAPY CENTER, LLP
Entity type:Organization
Organization Name:GREATER NEW HAVEN COUNSELING AND FAMILY THERAPY CENTER, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:F
Authorized Official - Last Name:CAMPAGNA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:203-407-1310
Mailing Address - Street 1:1844 WHITNEY AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-1400
Mailing Address - Country:US
Mailing Address - Phone:203-407-1310
Mailing Address - Fax:203-407-1309
Practice Address - Street 1:1844 WHITNEY AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517-1400
Practice Address - Country:US
Practice Address - Phone:203-407-1310
Practice Address - Fax:203-407-1309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-11
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CT1845106H00000X
CT5770363LP0808X, 363LP0808X
CT000614103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty