Healthcare Provider Details

I. General information

NPI: 1134407174
Provider Name (Legal Business Name): COMPASSIONATE PSYCHIATRIC CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 BOSTON POST RD SECOND FLOOR
MADISON CT
06443-2157
US

IV. Provider business mailing address

60 BOSTON POST RD SECOND FLOOR
MADISON CT
06443-2157
US

V. Phone/Fax

Practice location:
  • Phone: 203-421-6156
  • Fax: 203-421-6157
Mailing address:
  • Phone: 203-421-6156
  • Fax: 203-421-6157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number004454
License Number StateCT

VIII. Authorized Official

Name: SHARON E DURIVAGE
Title or Position: APRN-BC
Credential: APRN-BC
Phone: 203-421-6156