Provider Demographics
NPI:1679957732
Name:HOCKANUM VALLEY COMMUNITY COUNCIL
Entity type:Organization
Organization Name:HOCKANUM VALLEY COMMUNITY COUNCIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOJARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:860-872-9825
Mailing Address - Street 1:27 NAEK RD STE 4
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-3965
Mailing Address - Country:US
Mailing Address - Phone:860-872-9825
Mailing Address - Fax:860-870-9384
Practice Address - Street 1:27 NAEK RD STE 4
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-3965
Practice Address - Country:US
Practice Address - Phone:860-872-9825
Practice Address - Fax:860-870-9384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1898251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health