Healthcare Provider Details

I. General information

NPI: 1306361662
Provider Name (Legal Business Name): STONINGTON BEHAVIORAL HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 08/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 POQUONNOCK RD
GROTON CT
06340
US

IV. Provider business mailing address

618 POQUONNOCK RD
GROTON CT
06340
US

V. Phone/Fax

Practice location:
  • Phone: 860-445-3021
  • Fax:
Mailing address:
  • Phone: 860-445-3021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: STEVE FILTON
Title or Position: VICE PRESIDENT
Credential:
Phone: 610-768-3300