Healthcare Provider Details

I. General information

NPI: 1306586169
Provider Name (Legal Business Name): I SERVE BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 05/11/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 RIDGE RD
BLOOMFIELD CT
06002-1636
US

IV. Provider business mailing address

664 PROSPECT AVENUE. SUITE #100. HARTFORD, CT. 06105
BLOOMFIELD CT
06002-1636
US

V. Phone/Fax

Practice location:
  • Phone: 860-995-4194
  • Fax:
Mailing address:
  • Phone: 860-995-4194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JANINE RUSSELL
Title or Position: APRN
Credential: DNP
Phone: 860-995-4194