Provider Demographics
NPI:1174624423
Name:COMMUNITY MENTAL HEALTH AFFILIATES INC
Entity type:Organization
Organization Name:COMMUNITY MENTAL HEALTH AFFILIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:J
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-826-1358
Mailing Address - Street 1:233 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-4204
Mailing Address - Country:US
Mailing Address - Phone:860-826-1358
Mailing Address - Fax:860-229-8886
Practice Address - Street 1:233 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-4204
Practice Address - Country:US
Practice Address - Phone:860-826-1358
Practice Address - Fax:860-229-8886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0232261QM0801X
CT0301261QM0801X
CT0043261QM0801X
CT0275261QM0850X
CTRLC-0038320800000X
CT0368261QM0801X
CTC-0212261QM0801X
CT0276261QM0801X, 261QM0801X
CTC-0281261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004123650Medicaid
CT004161725Medicaid
CT008043474Medicaid
CT77ABH0015CT01OtherANTHEM BCBS PROVIDER #
CT008049178Medicaid
CT004246361Medicaid
CT004270906Medicaid
CT004161725Medicaid
CTB751683OtherSAGA GROUP NUMBER WIN.ST.
CT77ABH0015CT01OtherANTHEM BCBS PROVIDER #
CTB751769OtherSAGA GROUP NUMBER BRISTOL
CT004270914Medicaid
CT008044236Medicaid
CT008043474Medicaid