Healthcare Provider Details

I. General information

NPI: 1124405709
Provider Name (Legal Business Name): RIVER ROCK PSYCHIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2015
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 MAIN ST
MIDDLEFIELD CT
06455-1293
US

IV. Provider business mailing address

545 MAIN ST
MIDDLEFIELD CT
06455-1293
US

V. Phone/Fax

Practice location:
  • Phone: 860-918-4182
  • Fax:
Mailing address:
  • Phone: 860-918-4182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SUSAN MCNAMARA
Title or Position: MEMBER
Credential: M.D.
Phone: 860-918-4182