Healthcare Provider Details

I. General information

NPI: 1508347162
Provider Name (Legal Business Name): BRIGHT FUTURES WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422-426 HIGHLAND AVENUE
CHESHIRE CT
06410
US

IV. Provider business mailing address

PO BOX 104
CHESHIRE CT
06410-0104
US

V. Phone/Fax

Practice location:
  • Phone: 203-304-4961
  • Fax: 203-306-2905
Mailing address:
  • Phone: 203-304-4961
  • Fax: 203-306-2905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2442
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: HEIDI B WILDSTEIN
Title or Position: MANAGER
Credential: APRN
Phone: 203-304-4961