CONNECTICUT JUNIOR REPUBLIC ASSOCIATION, INC. - NPI 1174644926

Q: What is the provider's specialty?

The provider's specialty is Clinic/Center with taxonomy code 261QM0855X and a focus in Adolescent and Children Mental Health.

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About Connecticut Junior Republic Association, Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CONNECTICUT JUNIOR REPUBLIC ASSOCIATION, INC. (NPI 1174644926) is a healthcare organization registered as an adolescent and children mental health in Waterbury, Connecticut and active in the NPI registry since April 2007. The organization holds a CLIA Waiver certificate valid through September 23, 2026 and lists John F Boyd, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1174644926

Entity TypeOrganization

Primary Taxonomy261QM0855X

Legal Business NameCONNECTICUT JUNIOR REPUBLIC ASSOCIATION, INC.

Location Address80 PROSPECT STWaterbury, CT 06702-1327

Mailing Address550 Goshen Road, Po Box 161Litchfield, CT 06759-0161 · (860) 567-9423

Phone(203) 757-9939

Organization SubpartNo

Authorized OfficialJohn F BoydExecutive Director · (860) 567-9423

Enumeration DateApril 2, 2007

Last NPPES UpdateJune 30, 2008

✔ NPI 1174644926 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Adolescent and Children Mental HealthAmbulatory Health Care Facilities

Taxonomy Code261QM0855X

License✔ Licensed in CT · SA0189

Definition

An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training.

80 PROSPECT ST, Waterbury, CT 06702

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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 07D2311577

Connecticut Junior Republic Association · Litchfield, CT

Active · expires Sep 23, 2026

CLIA Number07D2311577

Laboratory TypeSchool/Student Health Service

Certificate Effective DateSeptember 24, 2024

Certificate Expiration DateSeptember 23, 2026

Laboratory DirectorDaniel W. Rezende

Laboratory Phone(860) 567-9423

Laboratory LocationConnecticut Junior Republic Association550 Goshen Road, Litchfield, CT 06759

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JACQUELINE ARROYO

Counselor (Addiction (Substance Use Disorder))