Healthcare Provider Details

I. General information

NPI: 1366958480
Provider Name (Legal Business Name): MANSFIELD MENTAL HEALTH AND ADDICTION MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2017
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 STORRS RD
MANSFIELD CENTER CT
06250-1638
US

IV. Provider business mailing address

207 STORRS RD
MANSFIELD CENTER CT
06250-1638
US

V. Phone/Fax

Practice location:
  • Phone: 347-872-3612
  • Fax: 860-942-8830
Mailing address:
  • Phone: 860-942-8826
  • Fax: 860-942-8830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number54266
License Number StateCT

VIII. Authorized Official

Name: DR. GENGYUN WEN
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 860-336-8017