Healthcare Provider Details

I. General information

NPI: 1467672592
Provider Name (Legal Business Name): COMPREHENSIVE PAIN AND HEADACHE TREATMENT CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 DIVISION STREET
DERBY CT
06418
US

IV. Provider business mailing address

130 DIVISION STREET
DERBY CT
06418
US

V. Phone/Fax

Practice location:
  • Phone: 203-732-1570
  • Fax: 203-732-1576
Mailing address:
  • Phone: 203-732-1570
  • Fax: 203-732-1576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEBORAH LECHNER
Title or Position: BILLING LEAD
Credential:
Phone: 203-732-1580