Provider Demographics
NPI:1366524100
Name:PUTNAM BOARD OF EDUCATION
Entity type:Organization
Organization Name:PUTNAM BOARD OF EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-963-6900
Mailing Address - Street 1:126 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1831
Mailing Address - Country:US
Mailing Address - Phone:860-963-6900
Mailing Address - Fax:860-963-6903
Practice Address - Street 1:126 CHURCH ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1831
Practice Address - Country:US
Practice Address - Phone:860-963-6900
Practice Address - Fax:860-963-6903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT251300000X251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004097665Medicaid