Healthcare Provider Details

I. General information

NPI: 1821969619
Provider Name (Legal Business Name): VATAS INTEGRATIVE PSYCHIATRY & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LEVERCH DR
EAST HARTFORD CT
06108
US

IV. Provider business mailing address

55 LEVERICH DR
EAST HARTFORD CT
06108-1432
US

V. Phone/Fax

Practice location:
  • Phone: 203-843-2264
  • Fax:
Mailing address:
  • Phone: 203-843-2264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CHIDINMA IFECHUKWU GUBOR
Title or Position: OWNER
Credential: DNP, APRN, PMHNP-BC
Phone: 203-843-2264