| New Haven Halfway House | |
|
109 Legion Ave New Haven CT 06519-5506 | |
| (203) 562-2264 | |
| (203) 789-1335 |
| Full Name | New Haven Halfway House |
|---|---|
| Speciality | Community Based Residential Treatment Facility, Mental Illness |
| Location | 109 Legion Ave, New Haven, Connecticut |
| Authorized Official Name and Position | Patti L Walker (PRESIDENT, CEO) |
| Authorized Official Contact | 2035622264 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New Haven Halfway House 109 Legion Ave New Haven CT 06519-5506 Ph: (203) 562-2264 | New Haven Halfway House 109 Legion Ave New Haven CT 06519-5506 Ph: (203) 562-2264 |
| NPI Number | 1922132083 |
|---|---|
| Provider Enumeration Date | 03/14/2007 |
| Last Update Date | 03/16/2021 |
| Certification Date | 03/16/2021 |
| Medicare PECOS PAC ID | 8921398876 |
|---|---|
| Medicare Enrollment ID | O20160606000184 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922132083 | NPI | - | NPPES |
| 004246501 | Medicaid | CT |
| Provider Name | Susan G Parke |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952440943 PECOS PAC ID: 1355497397 Enrollment ID: I20090916000747 |
| Provider Name | Ellyn Shander |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134278500 PECOS PAC ID: 6608058243 Enrollment ID: I20110303000398 |
| Provider Name | Maura J Dandrea |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003894734 PECOS PAC ID: 6406917376 Enrollment ID: I20140116000125 |
| Provider Name | Nicole Baker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568800670 PECOS PAC ID: 7113234402 Enrollment ID: I20150918001531 |
| Provider Name | John D Cahill |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1467690271 PECOS PAC ID: 2668774936 Enrollment ID: I20160104000494 |
| Provider Name | Gretchen E Elder |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831334127 PECOS PAC ID: 4082992391 Enrollment ID: I20161020001008 |
| Provider Name | Dominique G Coleman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891160206 PECOS PAC ID: 6507145075 Enrollment ID: I20161128001917 |
| Provider Name | Cynthia N Benoit |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346614542 PECOS PAC ID: 6305120296 Enrollment ID: I20170221000196 |
| Provider Name | Matthew E Puzycki |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073108940 PECOS PAC ID: 8820489511 Enrollment ID: I20220107001245 |
| Provider Name | Susan J. Kelly |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356773097 PECOS PAC ID: 3678966207 Enrollment ID: I20220203000916 |
| Provider Name | Kristy A Sinkovich |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225598824 PECOS PAC ID: 1052706918 Enrollment ID: I20220311002133 |
| Provider Name | Rachel Jean Maguire |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285305698 PECOS PAC ID: 3577959865 Enrollment ID: I20220414000428 |
| Provider Name | Sean Keiran |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578103222 PECOS PAC ID: 8921478926 Enrollment ID: I20230109002585 |
| Provider Name | Yichu Xu |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164137089 PECOS PAC ID: 8325498942 Enrollment ID: I20231222001400 |
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