Healthcare Provider Details

I. General information

NPI: 1154286623
Provider Name (Legal Business Name): NEWLEAF BEHAVIORAL HEALTH PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 PARKVIEW DR
AVON CT
06001-3453
US

IV. Provider business mailing address

64 PARKVIEW DR
AVON CT
06001-3453
US

V. Phone/Fax

Practice location:
  • Phone: 203-214-5586
  • Fax:
Mailing address:
  • Phone: 203-214-5586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHINEDU IBEMADU
Title or Position: MEMBER
Credential: APRN
Phone: 203-214-5586