Healthcare Provider Details

I. General information

NPI: 1245055383
Provider Name (Legal Business Name): HOPE BEHAVIORAL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BESTOR LN
BLOOMFIELD CT
06002-2485
US

IV. Provider business mailing address

1 BESTOR LN STE 208
BLOOMFIELD CT
06002-2485
US

V. Phone/Fax

Practice location:
  • Phone: 860-847-0035
  • Fax: 866-781-4443
Mailing address:
  • Phone: 860-847-0035
  • Fax: 866-781-4443

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: MRS. DORRETT YVETTE BLACK
Title or Position: PMHNP
Credential: APRN
Phone: 860-221-8068