Healthcare Provider Details

I. General information

NPI: 1639361819
Provider Name (Legal Business Name): CPS, LLC (CONSULTANT PSYCHIATRIC SERVICES)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 BART DR
COLLINSVILLE CT
06019-3045
US

IV. Provider business mailing address

79 BART DR
COLLINSVILLE CT
06019-3045
US

V. Phone/Fax

Practice location:
  • Phone: 860-352-2090
  • Fax:
Mailing address:
  • Phone: 860-352-2090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number003006
License Number StateCT

VIII. Authorized Official

Name: MS. DARLENE A KUPINSKI
Title or Position: APRN
Credential:
Phone: 860-352-2090