NPI 1174759963 · live from the CMS NPI Registry
Abundant Life Center
Social Worker, Clinical in Hartford, CT. National Provider Identifier 1174759963, active.
NPI record
| NPI | 1174759963 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Social Worker, Clinical 1041C0700X |
| Practice location | 2550 Main St, Hartford, CT 06120 |
| Practice phone | 860-548-9399 |
| Mailing address | Po Box 714, Hartford, CT 06142 |
| Enumerated | June 8, 2009 |
| Last updated | April 16, 2013 |
| Authorized official | Troy Moses, Ceo |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Community/Behavioral Health | 251S00000X | 001806 (CT) |
| Case Management | 251B00000X | 001806 (CT) |
| Social Worker, Clinical primary | 1041C0700X | 104100000x (CT) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.