Healthcare Provider Details

I. General information

NPI: 1124363171
Provider Name (Legal Business Name): BEHAVIORAL WELLNESS ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2012
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 BOSTON POST RD SUITE 203
MILFORD CT
06460-3537
US

IV. Provider business mailing address

849 BOSTON POST RD SUITE 203
MILFORD CT
06460-3537
US

V. Phone/Fax

Practice location:
  • Phone: 203-693-3311
  • Fax: 203-878-6749
Mailing address:
  • Phone: 203-693-3311
  • Fax: 203-878-6749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number028024
License Number StateCT

VIII. Authorized Official

Name: DR. JAY K BERKOWITZ
Title or Position: OWNER
Credential: MD
Phone: 203-693-3311