Healthcare Provider Details

I. General information

NPI: 1376309302
Provider Name (Legal Business Name): PATHFINDER RECOVERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 EAST MAIN STREET
BRANFORD CT
06405-2911
US

IV. Provider business mailing address

29 EVERGREEN TER
SEYMOUR CT
06483-3051
US

V. Phone/Fax

Practice location:
  • Phone: 203-599-3908
  • Fax: 203-210-8641
Mailing address:
  • Phone: 203-599-3908
  • Fax: 203-210-8641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DAVID J HENDRICKS
Title or Position: OWNER
Credential: MD
Phone: 203-813-4892