Healthcare Provider Details

I. General information

NPI: 1831647957
Provider Name (Legal Business Name): STRAUN HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2016
Last Update Date: 09/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 MILL ST BLDG B
EAST BERLIN CT
06023-1159
US

IV. Provider business mailing address

1224 MILL ST BLDG B
EAST BERLIN CT
06023-1159
US

V. Phone/Fax

Practice location:
  • Phone: 860-756-0455
  • Fax: 866-469-7058
Mailing address:
  • Phone: 860-756-0455
  • Fax: 866-469-7058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number050844
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number050844
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number050844
License Number StateCT

VIII. Authorized Official

Name: DR. TEO-CARLO STRAUN
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 860-756-0455