Healthcare Provider Details

I. General information

NPI: 1568096790
Provider Name (Legal Business Name): NORTHPOINT PSYCHIATRIC CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 05/18/2020
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 MAIN ST STE 412
MIDDLETOWN CT
06457-3359
US

IV. Provider business mailing address

363 MAIN ST STE 412
MIDDLETOWN CT
06457-3359
US

V. Phone/Fax

Practice location:
  • Phone: 860-799-1626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LAURIE HERNANDEZ
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 727-800-2332