Healthcare Provider Details

I. General information

NPI: 1831936277
Provider Name (Legal Business Name): SERENE PSYCHIATRIC & MEDICAL PRACTICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MATTHEW LN
BROAD BROOK CT
06016-1006
US

IV. Provider business mailing address

2 MATTHEW LN
BROAD BROOK CT
06016-1006
US

V. Phone/Fax

Practice location:
  • Phone: 860-348-7148
  • Fax:
Mailing address:
  • Phone: 860-348-7148
  • 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: AGNES ARHIN
Title or Position: OWNER
Credential:
Phone: 860-348-7148