Healthcare Provider Details

I. General information

NPI: 1053362814
Provider Name (Legal Business Name): CONNECTICUT MENTAL HEALTH SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 FARMINGTON AVE SUITE 309
FARMINGTON CT
06032-1909
US

IV. Provider business mailing address

270 FARMINGTON AVE SUITE 309
FARMINGTON CT
06032-1909
US

V. Phone/Fax

Practice location:
  • Phone: 860-677-5570
  • Fax: 860-677-9570
Mailing address:
  • Phone: 860-677-5570
  • Fax: 860-677-9570

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 TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DANA KRISCENSKI
Title or Position: OFFICE MANAGER
Credential:
Phone: 860-677-5570